Clinical Manifestations and Management of Left Ventricular Assist Device–Associated Infections

Background. Infection is a serious complication of left ventricular assist device (LVAD) therapy. Published data regarding LVAD-associated infections (LVADIs) are limited by single-center experiences and use of nonstandardized definitions. Methods. We retrospectively reviewed 247 patients who underw...

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Bibliographic Details
Published in:	Clinical infectious diseases 2013-11, Vol.57 (10), p.1438-1448
Main Authors:	Nienaber, Juhsien Jodi C., Kusne, Shimon, Riaz, Talha, Walker, Randall C., Baddour, Larry M., Wright, Alan J., Park, Soon J., Vikram, Holenarasipur R., Keating, Michael R., Arabia, Francisco A., Lahr, Brian D., Sohail, M. Rizwan
Format:	Article
Language:	eng
Subjects:	Adult Aged and Commentaries Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anti-Bacterial Agents - therapeutic use Antibiotics Antimicrobials ARTICLES AND COMMENTARIES Bacteria Biological and medical sciences Chi-Square Distribution Debridement Decision making Drivelines Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care Endocarditis Female Heart Heart assist devices Heart-Assist Devices - adverse effects Heart-Assist Devices - microbiology Humans Infections Infectious diseases Intensive care medicine Intervention Male Medical sciences Middle Aged Mortality Prosthesis-Related Infections - etiology Prosthesis-Related Infections - microbiology Prosthesis-Related Infections - therapy Prosthetics Pumps Retrospective Studies Transplants & implants
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Summary:	Background. Infection is a serious complication of left ventricular assist device (LVAD) therapy. Published data regarding LVAD-associated infections (LVADIs) are limited by single-center experiences and use of nonstandardized definitions. Methods. We retrospectively reviewed 247 patients who underwent continuous-flow LVAD implantation from January 2005 to December 2011 at Mayo Clinic campuses in Minnesota, Arizona, and Florida. LVADIs were defined using the International Society for Heart and Lung Transplantation criteria. Results. We identified 101 episodes of LVADI in 78 patients (32%) from this cohort. Mean age (± standard deviation [SD]) was 57±15 years. The majority (94%) underwent Heartmate II implantation, with 62% LVADs placed as destination therapy. The most common type of LVADIs were driveline infections (47%), followed by bloodstream infections (24% VAD related, and 22% non-VAD related). The most common causative pathogens included grampositive cocci (45%), predominantly staphylococci, and nosocomial gram-negative bacilli (27%). Almost half (42%) of the patients were managed by chronic suppressive antimicrobial therapy. While 14% of the patients had intraoperative debridement, only 3 underwent complete LVAD removal. The average duration (±SD) of LVAD support was 1.5±1.0 years. At year 2 of follow-up, the cumulative incidence of all-cause mortality was estimated to be 43%. Conclusion. Clinical manifestations of LVADI vary on the basis of the type of infection and the causative pathogen. Mortality remained high despite combined medical and surgical intervention and chronic suppressive antimicrobial therapy. Based on clinical experiences, a management algorithm for LVADI is proposed to assist in the decision-making process.
ISSN:	1058-4838 1537-6591