Multidrug-Resistant Organism Infections in Patients with Left Ventricular Assist Devices

Abstract

H eart failure is a chronic disease state with substantial morbidity and mortality rates.1 End-stage heart failure is characterized by worsening symptoms despite optimal medical management, and heart transplantation is the definitive treatment. However, rates of heart failure are increasing, whereas the number of organs available for transplantation is static.2 Therefore, mechanical support for the failing heart, especially ventricular assist devices (VADs), has attracted strong interest. Left VAD (LVAD) implantation imparts higher survival rates in end-stage heart failure than does optimal medical management.3-6 Although LVADs are potentially life-saving, implantation sequelae include right ventricular failure, thromboembolism, bleeding, and infection. Investigators have reported infection rates of 18% to 59% in patients with LVADs, and mortality rates estimated at 70% for infections such as VAD-related mediastinitis and endocarditis.3,7-9 Depending on the site of the infection, treatment can range from simple wound care to device explantation.7,10 Multidrug-resistant organisms (MDROs) are increasingly prevalent and are associated with substantial morbidity and mortality rates. 11-13Patients with LVADs are at greater risk for MDRO infection because of their exposure during medical procedures and their generally longer lifespans after implantation. To our knowledge, no data have been published about the incidence of MDRO infections in patients who have LVADs. Our primary objective in this study was to determine that incidence, and our secondary objective was to evaluate outcomes and risk factors in MDRO infection. Patients and MethodsOur retrospective cohort study included patients whose permanent LVADs had been implanted at

Left Ventricular Assist Device Infections: A Systematic Review

“…30 However, two other studies did not find infection to be associated with increased mortality, although they did show increased hospital length of stay in patients with infection. 23,31 LVAD infections were reported as a leading cause for readmission in 5 studies. 17,32–35…”

Infections in patients after Berlin Heart®EXCOR assist device implantation

“…To our knowledge, there is only one study reviewing such issue. Donahey et al 27 Besides, to our knowledge, there is no study assessing the potential relapse of BHED associated infection after HT. All three infections that relapsed were either VAD-S or VAD-R. Of note, relapsing infections occurred between 3 and 11 days after removal of the device and HT, which might suggest that an infection specific or related to the BHED, could be a harbinger of a future infection by the same microorganism few days after HT (especially if it is in close distance to the device).…”

“…To our knowledge, there is only one study reviewing such issue. Donahey et al . described a colonization rate of 31.6% with no significant differences in mortality or device explantation.…”

Trends, Outcomes, and Predictors of Sepsis and Severe Sepsis in Patients with Left Ventricular Assist Devices

“…This could be multifactorial in the setting of sepsis and also underlying comorbidities that would increase the mortality by itself. There were a few studies that showed no significant long-term outcomes in people with these infectious complications, although they showed increased length of hospital stay [12,[18][19]. A few studies have shown that LVAD infections have significant association with poor survival after adjusting for age and co-morbidities [20].…”