Bloodstream infections in mechanical circulatory support device recipients in the International Society of Heart and Lung Transplantation Mechanically Assisted Circulation Support Registry: Epidemiology, risk factors, and mortality

Aslam, Saima; Xie, Rongbing; Cowger, Jennifer; Kirklin, James K.; Chu, Vivian H.; Schueler, Stephan; By, T. de; Gould, Kate; Morrissey, Orla; Lund, Lars H.; Martin, Stanley I.; Goldstein, Daniel J.; Hannan, Margaret M.

doi:10.1016/j.healun.2018.04.006

Cited by 39 publications

(28 citation statements)

References 19 publications

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“…It is known that half of ICU patients had a nosocomial infection and are, therefore, at a high risk for sepsis [36]. Furthermore, as abovementioned, congested gut has been identified as a source of infection and is a known sepsis triggering problem in ICU patients with MOF, due to translocation of gut flora into the bloodstream [36,37].…”

Section: Discussionmentioning

confidence: 99%

Causes and predictors of early mortality in patients treated with left ventricular assist device implantation in the European Registry of Mechanical Circulatory Support (EUROMACS)

Akın

Soliman

et al. 2020

Intensive Care Med

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The aim of the study was to analyze early mortality after continuous-flow left ventricular assist device (LVAD) implantation which remains high. Methods: We analyzed consecutive (n = 2689) patients from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) undergoing continuous-flow LVAD implantation. The primary outcome was early (< 90 days) mortality. Secondary outcomes were differential causes of early post-operative death following LVAD implantation. Results: Univariable and multivariable analysis as well as regression analysis were used to examine determinants and differential causes of early (< 90 days) mortality after LVAD implantation. During the first 90 days, 2160 (80%) patients were alive with ongoing LVAD support, 40(2%) patients underwent heart transplantation, and 487(18%) deceased. The main causes of early death were MOF (36%), sepsis (28%), cardiopulmonary failure (CPF; 10%), CVA (9%), and rightsided heart failure (RHF, 8%). Furthermore, MOF and sepsis are 70% of causes of death in the first week. Independent clinical predictors of early death were age, female sex, INTERMACS profile 1 to 3, and ECMO. Laboratory predictors included elevated serum creatinine, total bilirubin, lactate, and low hemoglobin. Furthermore, hemodynamic predictors included elevated RA-to-PCWP ratio, pulmonary vascular resistance, and low systemic vascular resistance. Longer total implantation time was also independent predictor of early mortality. A simple model of 12 variables predicts early mortality following LVAD implantation with a good discriminative power with area under the curve of 0.75. Conclusions: In the EUROMACS registry, approximately one out of five patients die within 90 days after LVAD implantation. Early mortality is primarily dominated by multiorgan failure followed by sepsis. A simple model identifies important parameters which are associated with early mortality following LVAD implantation.

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Section: Discussionmentioning

confidence: 99%

Causes and predictors of early mortality in patients treated with left ventricular assist device implantation in the European Registry of Mechanical Circulatory Support (EUROMACS)

Akın

Soliman

et al. 2020

Intensive Care Med

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“…A recent study from the International Society of Heart and Lung Transplantation IMACS Registry, to which the EUROMACS Registry contributes, showed that early-onset BSI was associated with a significantly increased 24-month mortality rate and that 85% of these BSIs were not device related. There is an opportunity for infection prevention practices to decrease the BSI event rate in the intensive care unit and post-surgical settings, which may affect the 24-month survival rate [474].…”

Section: Infectionmentioning

confidence: 99%

2019 EACTS Expert Consensus on long-term mechanical circulatory support

Potapov

Antonides

Crespo-Leiro

et al. 2019

European Journal of Cardio-Thoracic Surgery

300

446

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Long-term mechanical circulatory support (LT-MCS) is an important treatment modality for patients with severe heart failure. Different devices are available, and many—sometimes contradictory—observations regarding patient selection, surgical techniques, perioperative management and follow-up have been published. With the growing expertise in this field, the European Association for Cardio-Thoracic Surgery (EACTS) recognized a need for a structured multidisciplinary consensus about the approach to patients with LT-MCS. However, the evidence published so far is insufficient to allow for generation of meaningful guidelines complying with EACTS requirements. Instead, the EACTS presents an expert opinion in the LT-MCS field. This expert opinion addresses patient evaluation and preoperative optimization as well as management of cardiac and non-cardiac comorbidities. Further, extensive operative implantation techniques are summarized and evaluated by leading experts, depending on both patient characteristics and device selection. The faculty recognized that postoperative management is multidisciplinary and includes aspects of intensive care unit stay, rehabilitation, ambulatory care, myocardial recovery and end-of-life care and mirrored this fact in this paper. Additionally, the opinions of experts on diagnosis and management of adverse events including bleeding, cerebrovascular accidents and device malfunction are presented. In this expert consensus, the evidence for the complete management from patient selection to end-of-life care is carefully reviewed with the aim of guiding clinicians in optimizing management of patients considered for or supported by an LT-MCS device.

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“…Higher body mass index has been shown to independently correlate with higher rates of both device related and non-VAD related infections (25), including blood stream infections (26).…”

Section: Host Factorsmentioning

confidence: 99%

Post-operative infection in mechanical circulatory support patients

Tan

Zeng

2020

Ann Transl Med

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The management of end stage heart failure has changed dramatically in recent years with the advent of mechanical circulatory support devices as well as rapid improvement and increased availability of these devices. With the improvements in survival and quality of life in these patients, post-operative infections become a significant contribution to morbidity and mortality. Post-operative infections need to be adequately addressed in a timely fashion by early diagnosis and appropriate treatment. Recognizing risk factors for infection and instituting good infection control measures is also key in caring for these patients. Multiple patient and device factors have been shown to be correlated with increased post-operative infections, and cellular immunity is also impaired in patients on ventricular assist devices (VAD). Cultures should be taken prior to starting antimicrobial treatment. Empirical treatment needs to account for common pathogens, local microbial resistance and subsequently be culture guided once results are available.Patients on extracorporeal membrane oxygenation present a unique challenge with drug dosing due to altered pharmacokinetics. VAD related and VAD specific infections require appropriate wound care and possible surgical intervention. This narrative review summarizes the literature available for the management and prevention of post-operative infections in patients with mechanical circulatory devices. Vigilance in identifying risk factors, prompt treatment and active prevention is crucial to the management.

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Bloodstream infections in mechanical circulatory support device recipients in the International Society of Heart and Lung Transplantation Mechanically Assisted Circulation Support Registry: Epidemiology, risk factors, and mortality

Cited by 39 publications

References 19 publications

Causes and predictors of early mortality in patients treated with left ventricular assist device implantation in the European Registry of Mechanical Circulatory Support (EUROMACS)

Causes and predictors of early mortality in patients treated with left ventricular assist device implantation in the European Registry of Mechanical Circulatory Support (EUROMACS)

2019 EACTS Expert Consensus on long-term mechanical circulatory support

Post-operative infection in mechanical circulatory support patients

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