Journal article
Risk factors and prognostic impact of left ventricular assist device–associated infections
The American heart journal, Vol.214, pp.69-76
08/2019
DOI: 10.1016/j.ahj.2019.04.021
PMID: 31174053
Abstract
Background - Left ventricular assist device (LVAD)-associated infections may be life-threatening and impact patients' outcome. We aimed to identify the characteristics, risk factors, and prognosis of LVAD-associated infections. Methods - Patients included in the ASSIST-ICD study (19 centers) were enrolled. The main outcome was the occurrence of LVAD-associated infection (driveline infection, pocket infection, or pump/cannula infection) during follow-up. Results - Of the 652 patients enrolled, 201 (30.1%) presented a total of 248 LVAD infections diagnosed 6.5 months after implantation, including 171 (26.2%), 51 (7.8%), and 26 (4.0%) percutaneous driveline infection, pocket infection, or pump/cannula infection, respectively. Patients with infections were aged 58.7 years, and most received HeartMate II (82.1%) or HeartWare (13.4%). Most patients (62%) had implantable cardioverter-defibrillators (ICDs) before LVAD, and 104 (16.0%) had ICD implantation, extraction, or replacement after the LVAD surgery. Main pathogens found among the 248 infections were Staphylococcus aureus (n = 113' 45.4%), Enterobacteriaceae (n = 61; 24.6%), Pseudomonas aeruginosa (n = 34; 13.7%), coagulase-negative staphylococci (n = 13; 5.2%), and Candida species (n = 13; 5.2%). In multivariable analysis, HeartMate II (subhazard ratio, 1.56; 95% CI, 1.03 to 2.36; P = .031) and ICD-related procedures post-LVAD (subhazard ratio, 1.43; 95% CI, 1.03-1.98; P = .031) were significantly associated with LVAD infections. Infections had no detrimental impact on survival. Conclusions - Left ventricular assist device-associated infections affect one-third of LVAD recipients, mostly related to skin pathogens and gram-negative bacilli, with increased risk with HeartMate II as compared with HeartWare, and in patients who required ICD-related procedures post-LVAD. This is a plea to better select patients needing ICD implantation/replacement after LVAD implantation.
Details
- Title: Subtitle
- Risk factors and prognostic impact of left ventricular assist device–associated infections
- Creators
- Pierre Tattevin - Hôpital PontchaillouErwan Flécher - Hôpital PontchaillouVincent Auffret - Laboratoire Traitement du Signal et de l'ImageChristophe Leclercq - Centre Hospitalier Universitaire de RennesStéphane Boulé - Centre Hospitalier Universitaire de LilleVincent Vincentelli - Centre Hospitalier Universitaire de LilleCamille Dambrin - Service Chirurgie Cardio-Vasculaire [CHU Toulouse]Clément Delmas - Equipe "Obésité et insuffisance cardiaque: approches moléculaires et cliniques "Laurent Barandon - Université de BordeauxVincent Veniard - Université de BordeauxMichel Kindo - Centre Hospitalier Régional Universitaire de StrasbourgThomas Cardi - Centre Hospitalier Régional Universitaire de StrasbourgPhilippe Gaudard - Physiologie et Médecine Expérimentale du Coeur et des MusclesArnaud Rouvière - Centre Hospitalier Régional Universitaire [Montpellier]Thomas Sénage - Centre Hospitalier Universitaire de NantesNicolas Jacob - Centre Hospitalier Universitaire de NantesPascal Defaye - Centre Hospitalier Universitaire de GrenobleOlivier Chavanon - Hôpital Albert MichallonConstance Verdonk - Hôpital Bichat-Claude-BernardMarylou Para - Hôpital Bichat-Claude-BernardEdeline Pelcé - Hôpital de la TimoneVlad Gariboldi - Hôpital de la TimoneLouis Pozzi - Hôpital Louis PradelLouis Grinberg - Hôpital Louis PradelArnaud Savouré - Centre Hospitalier Universitaire de RouenPierre-Yves Litzler - Service de chirurgie cadiovasculaire et thoracique [Rouen]Gerard Babatasi - Université de Caen NormandieAnnette Belin - Université de Caen NormandieFabien Garnier - Centre Hospitalier Universitaire de Dijon - Hôpital François MitterrandMarie Bielefeld - Centre Hospitalier Universitaire de Dijon - Hôpital François MitterrandDavid Hamon - Hôpitaux Universitaires Henri MondorNicolas Lellouche - Hôpitaux Universitaires Henri-MondorLouis Bernard - Bretonneau HospitalThierry Bourguignon - Centre Hospitalier Universitaire de ToursRomain Eschalier - Centre Hospitalier Universitaire de Clermont-FerrandNicolas d'Ostrevy - chirurgie cardio-vasculaireJérôme Jouan - Hôpital Européen Georges-PompidouEmilie Varlet - Hôpital EuropéenFabrice Vanhuyse - Centre Hospitalier Universitaire de NancyHugues Blangy - Centre Hospitalier Universitaire de NancyR.P. Martins - Hôpital PontchaillouVincent Galand - Centre Hospitalier Universitaire de Rennes
- Resource Type
- Journal article
- Publication Details
- The American heart journal, Vol.214, pp.69-76
- Publisher
- Elsevier
- DOI
- 10.1016/j.ahj.2019.04.021
- PMID
- 31174053
- ISSN
- 0002-8703
- eISSN
- 1097-6744
- Language
- English
- Date published
- 08/2019
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984694747202771
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