Left ventricular assist device-related infection: treatment and outcome.
BACKGROUND
Left ventricular assist device (LVAD) implantation has become an effective treatment option for patients with severe heart failure awaiting transplantation. Significant infection rates have been reported among LVAD recipients. However, few reports have focused specifically on device infection, its treatment, and the impact of LVAD-related infection on clinical outcome.


METHODS
Forty-six LVAD-related infections were diagnosed in 38 (50%) of 76 patients who underwent LVAD implantation as a bridge to transplantation. Twenty-nine episodes of LVAD-related bloodstream infection (BSI) (including 5 that were cases of LVAD endocarditis) and 17 episodes of local LVAD infection were identified.


RESULTS
Diabetes mellitus appeared to increase the risk of BSI among patients with LVAD infection. LVAD-related infection delayed transplantation, as reflected by longer device-support times (a mean duration +/- SEM of 182.8+/-31.1 days, compared with 66.3+/-8.8 days; P<or=.001). Continuous antimicrobial treatment before, during, and after transplantation was associated with fewer relapses than was a limited course of antibiotics (P<.001). A trend for longer hospital stays after receipt of a transplant and increased early mortality was observed in the cohort with LVAD-related infection, although long-term survival was similar to that associated with patients without LVAD-related infection. Posttransplantation invasive vancomycin-resistant Enterococcus faecium (VREF) infection was diagnosed in 6 patients with LVAD-related infection; 4 of these patients died. No VREF infections were identified in patients without LVAD-related infection.


CONCLUSIONS
Our observations suggest that LVAD-related infection is common and may require antimicrobial therapy before, during, and after transplantation, but that it does not prevent successful transplantation. However, patients with LVAD-related infection appear to be at increased risk for invasive VREF infection, which may contribute to early mortality after transplantation.
Simon
David
D
Section of Infectious Disease, Cardiology, Rush University Medical Center, Chicago, IL, USA. David_M_Simon@rush.edu <David_M_Simon@rush.edu>
Fischer
Staci
S
Grossman
Angela
A
Downer
Carol
C
Hota
Bala
B
Heroux
Alain
A
Trenholme
Gordon
G
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000209:etiology / Q000382:microbiology; D005260:Female; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000209:etiology* / Q000382:microbiology / Q000401:mortality; D012307:Risk Factors; D013997:Time Factors
D000900:Anti-Bacterial Agents