title: Prospective, multicenter study of ventricular assist device infections.
abstract: BACKGROUND
  Ventricular assist devices (VADs) improve survival and quality of life in patients with advanced heart failure, but their use is frequently complicated by infection. There are limited data on the microbiology and epidemiology of these infections.
  
  
  RESULTS
  One hundred fifty patients scheduled for VAD implantation were enrolled (2006-2008) at 11 US cardiac centers and followed prospectively until transplantation, explantation for recovery, death, or for 1 year. Eighty-six patients (57%) received HeartMate II devices. Data were collected on potential preoperative, intraoperative, and postoperative risk factors for infection. Clinical, laboratory, and microbiological data were collected for suspected infections and evaluated by an infectious diseases specialist. Thirty-three patients (22%) developed 34 VAD-related infections with an incidence rate of 0.10 per 100 person-days (95% confidence interval, 0.073-0.142). The median time to infection was 68 days. The driveline was the most commonly infected site (n=28); 18 (64%) were associated with invasive disease. Staphylococci were the most common pathogen (47%), but pseudomonas or other Gram-negative bacteria caused 32% of infections. A history of depression and elevated baseline serum creatinine were independent predictors of VAD infection (adjusted hazard ratio=2.8 [P=0.007] and 1.7 [P=0.023], respectively). The HeartMate II was not associated with a decreased risk of infection. VAD infection increased 1-year mortality (adjusted hazard ratio=5.6; P<0.0001).
  
  
  CONCLUSIONS
  This prospective, multicenter study demonstrates that infection frequently complicates VAD placement and is a continuing problem despite the use of newer, smaller devices. Depression and renal dysfunction may increase the risk of VAD infection. VAD infection is a serious consequence because it adversely affects patient survival.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01471795.
authors: Departments of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. rj216@columbia.edu
authors: Rachel J
authors: RJ
authors: Gordon
authors: Alan D
authors: AD
authors: Weinberg
authors: Francis D
authors: FD
authors: Pagani
authors: Mark S
authors: MS
authors: Slaughter
authors: Pat S
authors: PS
authors: Pappas
authors: Yoshifumi
authors: Y
authors: Naka
authors: Daniel J
authors: DJ
authors: Goldstein
authors: Walter P
authors: WP
authors: Dembitsky
authors: Julie C
authors: JC
authors: Giacalone
authors: Jennifer
authors: J
authors: Ferrante
authors: Deborah D
authors: DD
authors: Ascheim
authors: Alan J
authors: AJ
authors: Moskowitz
authors: Eric A
authors: EA
authors: Rose
authors: Annetine C
authors: AC
authors: Gelijns
authors: Franklin D
authors: FD
authors: Lowy
mesh_terms: D000328:Adult; D000368:Aged; D053821:Cardiovascular Infections / Q000453:epidemiology / Q000382:microbiology; D003404:Creatinine / Q000097:blood; D003863:Depression / Q000453:epidemiology; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006333:Heart Failure / Q000628:therapy; D006353:Heart-Assist Devices / Q000382:microbiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000382:microbiology*; D011552:Pseudomonas Infections / Q000453:epidemiology*; D012307:Risk Factors; D012720:Severity of Illness Index; D013203:Staphylococcal Infections / Q000453:epidemiology*; D016896:Treatment Outcome
chemical_list: D003404:Creatinine