title: Infections occurring in adult patients receiving mechanical circulatory support: the two-year experience of an Italian National Referral Tertiary Care Center.
abstract: OBJECTIVE
  Infection during mechanical circulatory support is a frequent adverse complication. We analyzed infections occurring in this population in a national tertiary care center, and assessed the differences existing between the setting of extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VADs).
  
  
  METHODS
  An observational study was made of patients treated with ECMO or VAD in the San Raffaele Scientific Institute (Italy) between 2009 and 2011.
  
  
  METHODS
  None.
  
  
  RESULTS
  Thirty-nine percent of the 46 patients with ECMO and 69% of the 15 patients with VAD developed infection. We observed a mortality rate of 36.1% during mechanical circulatory support and of 55.7% during the global hospitalization period. Although Gram-negative infections were predominant overall, patients with ECMO were more prone to develop Candida infection (29%), and patients with VAD tended to suffer Staphylococcus infection (18%). Patients with infection had longer ECMO support (p=0.03), VAD support (p=0.01), stay in the intensive care unit (p=0.002), and hospital admission (p=0.03) than patients without infection. Infection (regression coefficient=3.99, 95% CI 0.93-7.05, p=0.02), body mass index (regression coefficient=0.46, 95% CI 0.09-0.83, p=0.02), fungal infection (regression coefficient=4.96, 95% CI 1.42-8.44, p=0.009) and obesity (regression coefficient=10.47, 95% CI 1.77-19.17, p=0.02) were predictors of the duration of ECMO support. Stepwise logistic regression analysis showed the SOFA score at the time of implant (OR=12.33, 95% CI 1.15-132.36, p=0.04) and VAD (OR=1.27, 95% CI 1.04-1.56, p=0.02) to be associated with infection.
  
  
  CONCLUSIONS
  Infection is a major challenge during ECMO and VAD support. Each mechanical circulatory support configuration is associated with specific pathogens; fungal infections play a major role.
authors.affiliation: Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, Istituto Scientifico San Raffaele, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Pieri
authors.forename: N
authors.initials: N
authors.lastname: Agracheva
authors.forename: L
authors.initials: L
authors.lastname: Fumagalli
authors.forename: T
authors.initials: T
authors.lastname: Greco
authors.forename: M
authors.initials: M
authors.lastname: De Bonis
authors.forename: M C
authors.initials: MC
authors.lastname: Calabrese
authors.forename: A
authors.initials: A
authors.lastname: Rossodivita
authors.forename: A
authors.initials: A
authors.lastname: Zangrillo
authors.forename: F
authors.initials: F
authors.lastname: Pappalardo
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D015992:Body Mass Index; D058387:Candidemia / Q000453:epidemiology / Q000209:etiology*; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D003325:Coronary Care Units / Q000706:statistics & numerical data; D003953:Diagnosis-Related Groups; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D016469:Fungemia / Q000453:epidemiology / Q000209:etiology; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000209:etiology; D006353:Heart-Assist Devices / Q000009:adverse effects*; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D011014:Pneumonia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000209:etiology; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D014552:Urinary Tract Infections / Q000453:epidemiology