Journal Article

Left Ventricular Assist Device—Related Infection: Treatment and Outcome

David Simon, Staci Fischer, Angela Grossman, Carol Downer, Bala Hota, Alain Heroux and Gordon Trenholme

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 40, issue 8, pages 1108-1115
Published in print April 2005 | ISSN: 1058-4838
Published online April 2005 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/428728
Left Ventricular Assist Device—Related Infection: Treatment and Outcome

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Background. Left ventricular assist device (LVAD) implantation has become an effective treatment option for patients with severe heart failure awaiting transplantation. Significant infection rates have been reported among LVAD recipients. However, few reports have focused specifically on device infection, its treatment, and the impact of LVAD-related infection on clinical outcome.

Methods. Forty-six LVAD-related infections were diagnosed in 38 (50%) of 76 patients who underwent LVAD implantation as a bridge to transplantation. Twenty-nine episodes of LVAD-related bloodstream infection (BSI) (including 5 that were cases of LVAD endocarditis) and 17 episodes of local LVAD infection were identified.

Results. Diabetes mellitus appeared to increase the risk of BSI among patients with LVAD infection. LVAD-related infection delayed transplantation, as reflected by longer device-support times (a mean duration ± SEM of 182.8 ± 31.1 days, compared with 66.3 ± 8.8 days; P ⩽ .001). Continuous antimicrobial treatment before, during, and after transplantation was associated with fewer relapses than was a limited course of antibiotics (P < .001). A trend for longer hospital stays after receipt of a transplant and increased early mortality was observed in the cohort with LVAD-related infection, although long-term survival was similar to that associated with patients without LVAD-related infection. Posttransplantation invasive vancomycin-resistant Enterococcus faecium (VREF) infection was diagnosed in 6 patients with LVAD-related infection; 4 of these patients died. No VREF infections were identified in patients without LVAD-related infection.

Conclusions. Our observations suggest that LVAD-related infection is common and may require antimicrobial therapy before, during, and after transplantation, but that it does not prevent successful transplantation. However, patients with LVAD-related infection appear to be at increased risk for invasive VREF infection, which may contribute to early mortality after transplantation.

Journal Article.  3794 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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