Infectious complications of short-term ventricular assist devices
Abstract number: O135
Muñoz P., Padilla C., Barrio J.M., Ruiz M., Yañez J., Bouza E.
Background: VAD are mechanical pumps that take over the function of damaged ventricle/s in patients with heart failure until the recovery of myocardial function or as effective bridge before heart transplantation (HT). These critically-ill patients are prone to nosocomial and device-related infections and to non-infectious complications such as bleeding or thromboembolism. Most reports come from countries with long waiting-lists for heart transplantation (HT) with average supports that may exceed 100 d. In Spain, the average waiting time for HT is shorter, and VAD-related infections in this setting have not been sufficiently analysed.
Methods: During the period Jan 1989-March 2007, 58 patients required a VAD in our institution. Clinical and microbiological records were reviewed to determine the incidence, risk factors and outcome of nosocomial infections in these patients. Standard CDC (Centers for Disease Control) criteria were used for syndrome definitions.
Results: Mean age was 52 years and 62% were male. Median VAD support length was 3 days (152). Most common reason for VAD was postcardiotomy ventricular failure (56.9%), followed by allograft failure after HT (22.4%) and medical cardiogenic shock (20.7%). An infection (34 episodes) was diagnosed in 28 patients (50.9%): pneumonia (41%), urinary tract (14.7%), VAD infection (11.7%), wound infection (8.8%), catheter related (5.8%) and others (11.7%). S. aureus followed by Enterobacteriaceae, CNS and P. aeruginosa were the most common pathogens. In non-transplanted patients 27/32 died (85.1% of them due to a non-infectious cause) and 26 reached transplantation (80.8% despite having suffered an infection). At the end of VAD support, 38% of the patients were alive, 15.5% died due to cardiogenic failure and 15.5% of neurological complications. Infection accounted for 3.4% of the early deaths and for 19% of late demise.
Conclusion: Infections complicate the course of 51% of the patients requiring short-term VAD in our study but they do not preclude heart transplantation.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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