Risk factors and outcomes of fungal ventricular-assist device infections.
BACKGROUND
Infection is a common complication of ventricular-assist devices (VADs) and is associated with rehospitalization, thromboembolic events, VAD malfunction, delay in heart transplantation, and a high mortality rate. The objectives of this study were to investigate the frequency of fungal VAD infections and assess various risk factors and their effects on mortality as compared with bacterial VAD infections.


METHODS
We conducted a retrospective chart review of patients with infected VADs at a single tertiary care center. The frequency, risk factors, and outcomes of fungal versus bacterial VAD infections were compared.


RESULTS
Of the 300 patients who received a VAD, 108 (36%) developed VAD infection, including 85 bacterial and 23 fungal infections. Most common bacterial causes of infection were Staphylococcus aureus, coagulase-negative staphylococci, enterococci, and Pseudomonas aeuruginosa. The most common fungal etiologic agent was Candida albicans. Only the use of total parenteral nutrition was associated with the development of a fungal VAD infection in multivariate analysis (odds ratio, 6.95; 95% confidence interval, 1.71-28.16; P=.007). Patients who experienced fungal VAD infection were less likely to be cured (17.4% vs 56.3%; P=.001) and had greater mortality (91% vs 61%; P=.006), compared with those who experienced bacterial VAD infection.


CONCLUSIONS
Fungi were responsible for approximately one-fifth of VAD infections and were associated with a mortality rate of 91%. Restriction of total parenteral nutrition use is essential in decreasing the rate of fungal VAD infection. Trials are needed for investigating the use of echinocandins or lipid formulations of amphotericin B for prevention and/or treatment of fungal VAD infection.
Aslam
Saima
S
Baylor College of Medicine, Houston, Texas, USA. saslam@bcm.edu
Hernandez
Maria
M
Thornby
John
J
Zeluff
Barry
B
Darouiche
Rabih O
RO
D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality*; D005260:Female; D005658:Fungi / Q000145:classification / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology* / Q000401:mortality*; D010288:Parenteral Nutrition / Q000009:adverse effects; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents