Infections in children with left ventricular assist device

Abstract

Background: There are limited data about pediatric left ventricular assist device (VAD) infections in developing countries. This study aimed to investigate device postimplantation infectious complications and their pathogenic profile. Methods: Data were analyzed from patient charts involving 27 patients with dilated cardiomyopathy who underwent left VAD implantation at a leading tertiary care center in Turkey. Results: The study included 17 boys and ten girls with a median age of 12.22 years (range 17 months to 18 years). Nineteen patients were diagnosed with idiopathic, and three were diagnosed with familial dilated cardiomyopathy. Twenty-two out of 27 subjects (%81.48) developed 80 infection episodes in total. The most common type of left VAD-specific infection was the exit site of the driveline. Infected patients with left VAD had a significantly prolonged hospitalization compared with the patients without infection (P = .014). Infection-induced pediatric intensive care unit (ICU) admission was higher in patients with fungal infection(P = .023). Gram-positive staphylococci were the most commonly isolated bacterial pathogens, followed by Gram-negative bacteria. Five patients developed fungal infections. None of the fungal infection patients underwent transplantation(P = .035). Seven deaths occurred in our study group. All deaths were in the infected group. Mortality was associated with the presence of multidrug-resistant Gram-negative bacterial infections (P = .015), an increased number of infection episodes (P = .003), and hospitalization due to infection (P = .003). Conclusion: Ventricular assist device-related infections were frequent among our study patients. The predominantly isolated agents were Gram-positive bacterial pathogens. However, the emergence of relatively high rate of Gram-negative bacterial and fungal infections was associated with mortality before the transplantation. Establishing local programs for surveillance data, controlling for infection rates, and antibiotic stewardship are essential to reduce mortality of VAD patients in developing countries. K E Y W O R D S children, heart failure, infection, ventricular assist device TA B L E 3 Microorganisms isolated from all sites Microorganism No. Percent (%) Gram-positive microorganisms (n = 38) (60.32%) Methicillin-susceptible Staphylococcus aureus 20 31.75 Coagulase-negative Staphylococcus 8 12.69 Methicillin-resistant Staphylococcus aureus 5 7.93 Enterococcus faecium 2 3.17 Vancomycin-resistant enterococci 2 3.17 Nocardia 1 1.58 Gram-negative microorganism (n = 20) (31.75%) Pseudomonas aeroginusae 5 7.93 Acinetobacter baumanii 5 7.93 Klebsiella pneumonia 3 4.76 Stenotrophomonas maltophilia 3 4.76 ESBL E Coli 2 3.17 Proteus mirabilis 1 1.58 Elizabethkingea meningoceptica 1 1.58 Fungal isolates (n = 5) (7.93%

Myocardial recovery in children supported with a durable ventricular assist device—a systematic review

“…Some of our included studies seem to reflect this too. For example, some studies with older patients show lower recovery rates [ 15 , 16 , 21 , 25 ], whereas others with younger children show higher recovery rates [ 22 , 35 ].…”