Clinical manifestations and management of left ventricular assist device-associated infections.
BACKGROUND
Infection is a serious complication of left ventricular assist device (LVAD) therapy. Published data regarding LVAD-associated infections (LVADIs) are limited by single-center experiences and use of nonstandardized definitions.


METHODS
We retrospectively reviewed 247 patients who underwent continuous-flow LVAD implantation from January 2005 to December 2011 at Mayo Clinic campuses in Minnesota, Arizona, and Florida. LVADIs were defined using the International Society for Heart and Lung Transplantation criteria.


RESULTS
We identified 101 episodes of LVADI in 78 patients (32%) from this cohort. Mean age (± standard deviation [SD]) was 57±15 years. The majority (94%) underwent Heartmate II implantation, with 62% LVADs placed as destination therapy. The most common type of LVADIs were driveline infections (47%), followed by bloodstream infections (24% VAD related, and 22% non-VAD related). The most common causative pathogens included gram-positive cocci (45%), predominantly staphylococci, and nosocomial gram-negative bacilli (27%). Almost half (42%) of the patients were managed by chronic suppressive antimicrobial therapy. While 14% of the patients had intraoperative debridement, only 3 underwent complete LVAD removal. The average duration (±SD) of LVAD support was 1.5±1.0 years. At year 2 of follow-up, the cumulative incidence of all-cause mortality was estimated to be 43%.


CONCLUSIONS
Clinical manifestations of LVADI vary on the basis of the type of infection and the causative pathogen. Mortality remained high despite combined medical and surgical intervention and chronic suppressive antimicrobial therapy. Based on clinical experiences, a management algorithm for LVADI is proposed to assist in the decision-making process.
Division of Infectious Diseases.
Juhsien Jodi C
JJ
Nienaber
Shimon
S
Kusne
Talha
T
Riaz
Randall C
RC
Walker
Larry M
LM
Baddour
Alan J
AJ
Wright
Soon J
SJ
Park
Holenarasipur R
HR
Vikram
Michael R
MR
Keating
Francisco A
FA
Arabia
Brian D
BD
Lahr
M Rizwan
MR
Sohail
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects* / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000382:microbiology / Q000628:therapy*; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents
LVAD; device-related infections; driveline infections; endocarditis; heart failure