Ten‐year retrospective cohort analysis of ventricular assist device infections

Abstract

Background:The number of patients treated by ventricular assist devices (VAD) and the duration of VAD treatment is increasing. One of the main complications in terms of morbidity and mortality for VAD patients are microbial infections.With this study, we aimed to investigate the epidemiology and microbiological characteristics of infections occurring in a VAD population to identify modifiable factors. Methods:We retrospectively analyzed patient characteristics, treatments and outcomes of VAD-specific/related infections. All patients implanted in our institution with a continuous flow VAD between January 2009 and January 2019 were included. Risk factors for VAD infection were assessed using simple and multiple linear regressions. Results:Of the 104 patients screened, 99 were included in the analysis, the majority of which were men (78%). At implantation, the mean age was 56 years and the median time on VAD support was 541 days. The overall infection rate per year per patient was 1.4. Forty-seven patients (60%) suffered from VAD-specific/related infection. Half of all infection episodes occurred in the first 4 months but the proportion of VAD-specific/related infection was higher after the first 4 months (74% of all infection). Using regression models, no patient specific risk factors were associated with VAD-specific/related infections. Conclusion:No predictive factors for infection during VAD support were identified in this study. By extension, diabetes, renal insufficiency, age or high BMI are not sufficient to deny a patient access to ventricular support.

Daptomycin Pharmacokinetics in Blood and Wound Fluid in Critical Ill Patients with Left Ventricle Assist Devices

“…Gram-positive bacterial infections, mainly staphylococci and enterococci, are the most frequently isolated pathogens [33][34][35]. The continuous cutaneous defect by the driveline exit site represents an entry point for bacteria, increasing the frequency of LVAD infections [36,37]. Further risk factors, such as obesity (body mass index >30 kg/m 2 ), diabetes mellitus, chronic kidney disease (glomerular filtration rate <60 mL/min/1.73 m 2 ), history of previous mechanical circulatory support, and previous intensive care unit stay (>2 weeks), contribute to this vulnerability, especially for these patients [15].…”

Timelines of adverse event journeys of LVAD patients

“…The temporal aspect of this Events data provides a natural ordering of events with an inherent semantic structure. Previous studies based on the Events dataset over the past decades focused on individual AEs (for example right heart failure, 2 bleeding, 3 infection 4 etc.) Investigators have yet to focus on the timeline of the AE journey of LVAD patients, for example to investigate the duration of the AE journey (time between the first and last AE) or the most common time at which the first or last AE occurs.…”