Incidence of Healthcare-Associated Infections in a Pediatric Population With an Extracorporeal Ventricular Assist Device

Abstract

During the last decade, ventricular assist devices (VADs) have become a precious tool to support children with end-stage heart failure. However, thromboembolic events, bleeding, and infections may have a considerable impact on outcome. We retrospectively analyzed the incidence of healthcare-associated infections (HAIs) in nine patients supported by EXCOR Pediatric (Berlin Heart [BH]) VAD in a pediatric cardiosurgical intensive care unit between January 1, 2009 and March 31, 2011 (27 months). Median age was 8 months (interquartile range [IQR] 6-11), median weight 7.5 kg (IQR 4.5-8.5). Seven patients were supported with a left VAD, two with a biventricular VAD (BiVAD). Six patients with a left VAD underwent heart transplant after 89 days (median, IQR 41-143) of support. One patient is still on the waiting list. All patients with BiVAD died after 12 days of assistance due to VAD malfunction. Sixteen HAIs were reported in five out of nine patients (56%). All infected patients were supported by a left VAD. When compared with noninfected patients, they had a longer mechanical support period (median 131 days, IQR 75-164, vs. 25 days, IQR 11-61, P = 0.03), a longer intensive care unit stay (median 159 days, IQR 85-188, vs. 48 days, IQR 17-87, P = 0.06) and a longer length of hospital stay (median 186 days, IQR 105-222, vs. 64 days, IQR 34-113, P = 0.06). Overall, nine mechanical devices were replaced for thromboembolic issues, most of them (67%) in patients with VAD-related infections. Overall, infection rate was 17.6 per 1000 patients days, 1.3 BH endocarditis per 1000 BH days, 4.0 surgical sites infections per 1000 BH days, 12.5 central line-associated blood stream infections per 1000 central venous catheter days, 5 catheter-associated urinary tract infections per 1000 urinary catheter days, and 13.5 ventilator-associated pneumonia cases per 1000 mechanical ventilation days. Overall, VAD-related infections were 5.4 per 1000 BH days. Of the 17 isolated pathogens, 53% were Gram-negative rods, with a prevalence of Pseudomonas aeruginosa (35.3%). Four bacteria were multidrug resistant (25%), three were carbapenem-resistant P. aeruginosa (50% of all isolated pseudomonads), and one was a methicillin-resistant S. aureus. VADs used as a bridge to cardiac transplantation are associated with a large number of HAIs. Patients with infected VADs were admitted for longer time in intensive care and in hospital with increased healthcare costs but with no impact on survival.

Infections in patients after Berlin Heart®EXCOR assist device implantation

“…In other series, comprising both children and adults, with BHED and other LVADs, infection rates were lower compared to our results, varying from 22.6% to 63.0% . However, not all studies used the ISHLT definitions nor included all infection types as we did, with the consequent possibility of bias since they might have included only certain types of infections; thus lowering their incidence of infectious episodes.…”

Long‐Term Mechanical Circulatory Support in Pediatric Patients

“…One patient (11.1%) had aortic regurgitation. The LV median ejection fraction was 20% (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Eight patients (88.8%) needed inotropic support prior to HeartWare implantation, usually milrinone, dobutamine, and epinephrine.…”

“…The reported incidence of infectious complications in pediatric patients with VADs varies widely between 30 and 56% (18,19). The infectious complications could be severe (20), sometimes with fatal outcome.…”

Anesthesia for Cardiac Surgery in Neonates

“…It should be emphasized that while all these forms of support are lifesaving and offer the only option for survival in many infants, they are associated with signifi cant morbidity and even death. Major complications usually are of a hemorrhagic, thromboembolic, [ 315 ]. They can produce devastating consequences to the central nervous system.…”