title: Bacteraemia in ventricular assist devices: a common complication that need not affect clinical outcomes.
abstract: BACKGROUND
  Ventricular assist device (VAD) implantation has become an effective option for patients with severe heart failure. However, device-related infections remain a significant problem. The aim of this study was to describe the incidence and microbiological aetiology of bacteraemia in patients with VADs, and to assess the impact of bacteraemia on clinical outcomes.
  
  
  METHODS
  A retrospective study was conducted of patients having VAD implantation at the Alfred Hospital (Melbourne, Australia) from October 1990 to July 2009. Medical records and microbiology databases were reviewed. Patients who were supported with a VAD for 72h or more were evaluated for demographic data, VAD type, the occurrence of bacteraemia and clinical outcomes.
  
  
  RESULTS
  During the 19-year period, 135 VAD patients (89 Thoratec PVAD, 10 Novacor, and 36 Ventrassist) supported for a total duration of 17,304 (median 74) support days were included. Sixty-one patients (45%) developed VAD-associated bacteraemia, an incidence of 5.6 episodes per 1000 support days. The incidence of bacteraemia per 1000 days of support was similar for the three devices used: Thoratec PVAD, Novacor and Ventrassist VADs (7.8±0.8, 5.2±1.5 and 3.4±0.5, respectively, p=0.74). Staphylococcus aureus was the most common pathogen (25%). The rates of death on device, survival to transplant, recovery with explant and outcomes after transplantation, including 30-day mortality, median survival time and incidence of cerebrovascular accidents were not significantly impacted upon by bacteraemia.
  
  
  CONCLUSIONS
  Bacteraemia is common in VAD patients. However, the incidence of VAD-associated bacteraemia is independent of device type and with aggressive antimicrobial therapy; clinical outcomes need not be affected by the bacteraemia.
authors.affiliation: Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Australia. Electronic address: f.rosenfeldt@alfred.org.au.
authors.forename: Franklin L
authors.initials: FL
authors.lastname: Rosenfeldt
authors.affiliation: Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Australia.
authors.forename: Lachlan J
authors.initials: LJ
authors.lastname: Kwa
authors.affiliation: Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Australia.
authors.forename: Pramote
authors.initials: P
authors.lastname: Porapakkham
authors.affiliation: Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Australia.
authors.forename: Suraindra
authors.initials: S
authors.lastname: Rajadurai
authors.affiliation: Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Australia.
authors.forename: Kylie
authors.initials: K
authors.lastname: Jones
authors.affiliation: Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Australia.
authors.forename: Juliana
authors.initials: J
authors.lastname: van de Merwe
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Baki
authors.initials: B
authors.lastname: Billah
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Pornwalee
authors.initials: P
authors.lastname: Porapakkham
authors.affiliation: Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Australia.
authors.forename: Donald S
authors.initials: DS
authors.lastname: Esmore
authors.affiliation: Department of Microbiology and Infectious Diseases, Alfred Hospital, Melbourne, Australia.
authors.forename: Dag S
authors.initials: DS
authors.lastname: Halvorsen
authors.affiliation: Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Australia.
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Aguirre
authors.affiliation: Department of Microbiology and Infectious Diseases, Alfred Hospital, Melbourne, Australia.
authors.forename: Denis W
authors.initials: DW
authors.lastname: Spelman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016470:Bacteremia / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D013211:Staphylococcus aureus; D015996:Survival Rate
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bacteraemia; Bridge to transplantation; Destination therapy; Transplantation; Ventricular assist device