Ventricular assist device-related infections
Abstract number: P619
Gkouziouta A., Sfirakis P., Louca L., Adamopoulos S., Voudris V., Saroglou G., Alivizatos P.
Objectives: Heart failure remains a leading cause of death in developed countries despite medical management. Heart transplantation (HTx), a proven lifesaving intervention, is limited by donor availability. Ventricular assist devices (VADs) provide temporary support for patients with severe heart failure until transplantation or more seldom myocardial recovery. Assist devices may be used permanently for those ineligible for transplantation having demonstrated a survival benefit and an improved quality of life. Infection, in 18%-59% of cases, may involve any component of the device causing substantial mortality and morbidity.
Methods: We retrospectively reviewed the medical records of 39 patients with implantable VAD at the Onassis Cardiac Surgery Centre supported longer than 72 hours, from February 2003 through September 2008. Infection types included primary bacteraemia, septicaemia, endocarditis, pocket, driveline and exit site infection.
Results: In 39 patients supported with VAD, 9 developed 14 VAD related infections. Primary bacteraemia in 4 patients, VAD endocarditis in 3, while driveline and exit site infection occurred in 7 patients. Duration of VAD support was longer in infected patients (2648 days) vs. uninfected ones (1500 days). Pathogens identified: Staphylococcus epidermidis (4), Pseudomonas aeruginosa (4), Klebsiella pneumoniae (2), Acinetobacter baumannii (2), Proteus mirabilis (1) and Candida parapsilosis (1) were also identified. Five patients were successfully treated with i.v. antibiotic usage. Four patients were urgently transplanted due to septicaemia from multi antibiotic resistant nosocomial pathogens not responding to antibiotic treatment. One patient died from polymicrobial bacteraemia with Klebsiella pneumoniae, Stenotrophomonas maltophilia and Candida albicans. We were unable to transplant him due to lack of donor heart.
Conclusions: Infection remains the most common complication for VAD application. Development of appropriate strategies is essential such as continuous clinical surveillance, continuous patient clinical surveillance and infection control preventive measures are essential in a HT-VAD unit to prevent and manage device related infections in the MDR pathogen era.
|Session name:||19th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Helsinki, Finland, 16 - 19 May 2009|
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