Risk Factors and Outcomes of Fungal Ventricular‐Assist Device Infections

Abstract

Background Infection is a common complication of ventricular-assist devices (VADs) and is associated with re-hospitalization, thromboembolic events, VAD malfunction, delay in heart transplantation, and a high mortality rate. The objectives of this study were to investigate the frequency of fungal VAD infections and assess various risk factors and their effects on mortality as compared to bacterial VAD infections. Methods We conducted a retrospective chart review of patients with infected VADs at a single tertiary care center. The frequency, risk factors and outcomes of fungal vs. bacterial VAD infections were compared. Results Of the 300 patients who received a VAD, 108 (36%) developed VAD infection, including 85 bacterial and 23 fungal infections. Most common bacterial causes of infection were Staphylococcus aureus, coagulase-negative staphylococci, enterococci and Pseudomonas aeuruginosa. Most common fungal etiologic agent was Candida albicans. Only the use of TPN was associated with the development of a fungal VAD infection in multivariate analysis (OR 6.95, 95% CI 1.71–28.16, p=0.007). Patients who suffered from fungal VAD infection were less likely to be cured (17.4% vs. 56.3%, p=0.001) and had greater mortality (91% vs. 61%, p=0.006), as compared with those who experienced bacterial VAD infections. Conclusions Fungi were responsible for approximately one-fifth of VAD infections and were associated with a mortality rate of 91%. Restriction of TPN use is essential in decreasing the rate of fungal VAD infection. Trials are needed for investigating the use of echinocandins or lipid formulations of amphotericin B for prevention and/or treatment of fungal VAD infections.

Left ventricular assist device-related infections: a multicentric study

“…Previous reports found an incidence of 182 LVAD-related infections similar to our cohort, but with a median time from LVAD 183 implantation that was slightly longer, at 4.4 to 7.4 months [13,15], as compared to 2.9 months 184 in our study. These discrepancies may be related to the close monitoring routinely 185 implemented after LVAD implantation in our centers, to limited sample size, or to the fact 186 that 58% of our patients were classified as INTERMACS I by the time of implantation, which 187 has been associated with earlier first pump-related infection [16].…”

Cardiovascular Implantable Device Infections

“…Overall, VAD-related infection affects 13% to 80% of patients [7,65], and the cumulative risk of infection increases with the duration of VAD use [66]. The median time to diagnosis of VAD infection is usually within the first 30 days [67,68]. Infection of these devices is associated with a higher rate of rehospitalization, thromboembolic events, VAD malfunction, delay in heart transplantation, and probably a higher mortality rate [65,67].…”

“…The median time to diagnosis of VAD infection is usually within the first 30 days [67,68]. Infection of these devices is associated with a higher rate of rehospitalization, thromboembolic events, VAD malfunction, delay in heart transplantation, and probably a higher mortality rate [65,67].…”

“…The most common site for infection is the driveline [67], but VAD-related endocarditis is associated with the highest mortality rate. More than half of all VAD-related infections include multiple sites [67,69]. Unfortunately, unlike CIED-related infections, it may not be possible to replace the entire infected VAD until heart transplantation is accomplished.…”

“…As with CIED and prosthetic valve infections, staphylococci are the most common cause of VAD infections [67,68]. However, Gram-negative bacteria and fungi (mainly Candida) are more frequent, each occurring in about 20% of patients [66][67][68].…”