title: Risk analysis of bloodstream infection during long-term left ventricular assist device support.
abstract: BACKGROUND
  Infection during left ventricular assist device (LVAD) support is associated with a high mortality. This study investigated the effect of bloodstream infection on survival of patients with LVAD support and assessed risk factors for survival in LVAD patients with bloodstream infection.
  
  
  METHODS
  Between 1999 and 2010, 109 consecutive patients with end-stage heart failure were supported by an LVAD as a bridge to transplantation. Overall survival was compared between those with and without a bloodstream infection. Risk factors for survival of patients with bloodstream infection were analyzed.
  
  
  RESULTS
  A bloodstream infection developed in 65 patients (60%) during 584 ± 389 days of LVAD support. Compared with patients without a bloodstream infection, overall survival was significantly worse in those with bloodstream infection (68% vs 84% at 2 years after LVAD implantation, p = 0.0117). However, of 22 patients bridged to transplantation, none had bloodstream infection recurrence after transplantation, and their 3-year survival rate after transplantation was 100%. Cox multivariate analysis (hazard ratio [95% confidence interval]) identified postoperative right ventricular failure (2.890 [1.238 to 6.757]; p = 0.0141) and bloodstream infection caused by a pathogen other than gram-positive cocci (3.336 [1.390 to 8.006] p = 0.0070) as significant risk factors for death in LVAD patients with a bloodstream infection.
  
  
  CONCLUSIONS
  Bloodstream infection had a significant effect on survival after LVAD implantation. Our results suggest that urgent cardiac transplantation should be considered for LVAD patients with a bloodstream infection based on the causative organism and right ventricular function.
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan. ktoda2002@yahoo.co.jp
authors.forename: Koichi
authors.initials: K
authors.lastname: Toda
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Yonemoto
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Fujita
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Shimahara
authors.forename: Shyunsuke
authors.initials: S
authors.lastname: Sato
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakatani
authors.forename: Junjiro
authors.initials: J
authors.lastname: Kobayashi
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D016459:Prosthesis-Related Infections / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors