Lactobacillus jensenii is a gram-positive bacillus in the female genital tract believed to be a commensal organism that inhibits the growth of more virulent pathogens. Prevotella bivia is a gram-negative bacillus species also typically commensal in the female genital tract. Lactobacillus as the primary causative agent in perinephric abscesses and bacteremia has been documented, albeit very uncommon and opportunistic. Prevotella bivia is not classically associated with perinephric abscesses but has been implicated in rare cases of pelvic inflammatory disease and tubo-ovarian abscesses. In this report, we present a 26-year-old immunocompetent woman with a recent history of nephrolithiasis treated with lithotripsy, ureteral stent placement and removal, and antibiotics who was admitted for fever and severe right flank pain. Imaging showed a right-sided renal and perinephric abscesses colonized by Lactobacillus jensenii and Prevotella bivia. Blood cultures were also positive for Lactobacillus species. Per literature review, intravenous ceftriaxone and metronidazole were administered with successful resolution of abscesses and negative repeat blood cultures. To our knowledge, this is the first case of simultaneous renal system abscesses caused by Lactobacillus and Prevotella species. Nephrolithiasis and prior antibiotics likely contributed to the opportunistic pathogenesis in this otherwise immunocompetent patient.

Background: Frailty is prevalent in advanced heart failure patients and may help distinguish patients at risk of worse outcomes. However, the effect of frailty on postoperative clinical outcomes is still understudied. Therefore, we aim to study the relationship between frailty and postoperative clinical outcomes in patients undergoing long-term mechanical circulatory support (MCS).Methods: Forty-six patients undergoing durable MCS (left ventricular assist device and total artificial heart) placement at our medical center were assessed for frailty pre-implant. Frailty was defined as ≥ 3 physical components of the Fried frailty phenotype. Our primary endpoint is 1 year of survival post-implant. Secondary endpoints include 30-day all-cause rehospitalization, pump thrombosis, neurological event (stroke/transient ischemic attack), gastrointestinal bleeding, and driveline infection within 12 months post-MCS support.Results: Of the 46 patients, 32 (69%) met the criteria for frailty according to Fried. The cohort's median age was 67.0 years. The frail group had statistically significant lower left ventricular ejection fraction (LVEF) (11% vs. 20%, P = 0.017) and lower albumin (3.5 vs. 4.0 g/dL, P = 0.021). The frail cohort also had significantly higher rates of comorbid chronic kidney disease (47% vs. 7%, P = 0.016). There were no differences between the frail vs. non-frail group in terms of 30-day readmission rates (40% vs. 39%, P = 0.927) and 1-year postintervention survival (log-rank, P = 0.165). None of the other secondary endpoints reached statistical significance, although the incidence of gastrointestinal bleed (24% vs. 16%, P = 0.689) and pump thrombosis (8% vs. 0%, P = 0.538) were higher in the frail group.Conclusions: Preoperative Fried frailty was not associated with re-admission at 30 days, mortality at 365 days, and other postoperative outcomes in long-term durable MCS patients. Findings may need further validation in larger studies.

Objectives Heart failure impacts patients’ functional capabilities, ultimately leading to frailty. The use of a left ventricular assist device (LVAD) is acceptable as both destination therapy and bridge to transplant in heart failure management. We aim to evaluate the prognostic value of the Clinical Frailty Scale (CFS) on outcomes in older patients undergoing implantation of LVAD. Methods We conducted a retrospective chart review of patients ≥ 60 years old that underwent LVAD implantation at our medical center from May 1, 2018, to October 30, 2020. CFS was retrospectively assigned before LVAD placement and CFS scores > 4 was considered frail. Kaplan–Meier curves and Cox regression were used to analyze 1‐year survival estimates. Results Forty percent of the cohort was classified as frail according to CFS. Thirty‐day re‐admission rates were comparable between frail and non‐frail patients (46% vs 35%; P = 0.419). 1‐year survival was lower in the frail vs non‐frail group (log rank, P = 0.017). On Cox analysis, only frailty was associated with 1‐year post‐intervention mortality (hazard ratio [HR] = 5.64, 95% confidence interval [CI] = 1.131–28.212; P = 0.035). Conclusions CFS‐defined frailty was associated with increased risk of 1‐year mortality after LVAD implantation. CFS may be a valuable tool in the frailty assessment for risk stratification of patients undergoing LVAD implantation. Multicenter studies are required to validate these findings.

Background and Objectives: Heparin-induced thrombocytopenia (HIT) increases the risk of thromboembolic and bleeding events. HIT is also a well-known complication in patients undergoing left ventricular assist device (LVAD) implantation, although most studies are limited to case reports/series and single-center experiences. The main objective of this study is to examine the incidence and impact of HIT on outcomes in LVAD implants using a nationwide database. Methods: Using the National Inpatient Sample database (2007-2014), we identified patients ≥ 18 years that underwent LVAD implants using ICD-9 codes. LVAD implants were stratified by the presence of HIT. The primary and secondary endpoints were the impact of HIT on mortality and other outcomes respectively. Results: Out of the 15,083 LVAD implantations, HIT occurred in 331 (2.2%). Although not statistically significant, the annual incidence of HIT rose from 1.3% in 2009, peaked at 3.3% in 2012 and decreased to 2.0% (ptrend = 0.6171). In-hospital mortality (OR 2.21, 95% CI 1.30-3.74, p = 0.0034) and post-operative DVT/PE (OR 2.45, 95% CI 1.09-5.51, p = 0.0303) were significantly associated with HIT. Our analysis did not show any differences in the incidence of vascular complications, post-op stroke/TIA, hemorrhage requiring transfusion and acute kidney injury between HIT and non-HIT group. The HIT group stayed longer in the hospital (30 vs 27 days, p < 0.0001) and incurred higher total hospital charges ($695,834 vs. $640,089 p < 0.0001). Conclusion: Among patients undergoing LVAD implants, HIT was associated with higher risk of in-hospital mortality, post-op DVT/PE, higher hospital charges and longer hospital stay.