title: Persistent blood stream infection in patients supported with a continuous-flow left ventricular assist device is associated with an increased risk of cerebrovascular accidents.
abstract: BACKGROUND
  Common adverse events in patients supported with Continuous-flow left ventricular assist devices (CF-LVAD) include infections and cerebrovascular accidents (CVA). Some studies have suggested a possible association between blood stream infection (BSI) and CVA.
  
  
  RESULTS
  Medical records of patients who received Heartmate II (HMII) CF-LVADs in 2008-2012 at a single center were reviewed. CVA was categorized as either hemorrhagic (HCVA) or ischemic (ICVA). BSI was divided into persistent (pBSI) and nonpersistent (non-pBSI). pBSI was defined as BSI with the same organism on repeated blood culture >72 hours from initial blood culture despite antibiotics. Univariate and multivariate analyses were performed to determine predictors. A total of 149 patients had HMII implanted; 76% were male, and the overall mean age was 55.4 ± 13 years. There were a total of 19 (13%) patients who had CVA (7 HCVA and 12 ICVA) at a median of 295 days (range 5-1,096 days) after implantation. There were a total of 28 (19%) patients with pBSI and 17 (11%) patients with non-pBSI. Patients with pBSI had a trend toward greater BMI (31 kg/m(2) vs 27 kg/m(2); P = .09), and longer duration of support (1,019 d vs 371 d; P < .001) compared with those with non-pBSI. Persistent BSI was associated with an increased risk of mortality and with all-cause CVA on multivariate analysis (odds ratio [OR] 5.97; P = .003) as well as persistent Pseudomonas aeruginosa infection (OR 4.54; P = .048).
  
  
  CONCLUSIONS
  Persistent BSI is not uncommon in patients supported by CF-LVAD and is highly associated with all-cause CVA and increased all-cause mortality.
authors.affiliation: Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas; Houston Methodist JC Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, Texas. Electronic address: btrachtenberg@houstonmethodist.org.
authors.forename: Barry H
authors.initials: BH
authors.lastname: Trachtenberg
authors.affiliation: Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Cordero-Reyes
authors.affiliation: Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas; Department of Cardiology, University of Texas Medical Branch, Galveston, Texas.
authors.forename: Molham
authors.initials: M
authors.lastname: Aldeiri
authors.affiliation: Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Paulino
authors.initials: P
authors.lastname: Alvarez
authors.affiliation: Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas; Houston Methodist JC Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Arvind
authors.initials: A
authors.lastname: Bhimaraj
authors.affiliation: Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas; Houston Methodist JC Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Guha
authors.initials: G
authors.lastname: Ashrith
authors.affiliation: Houston Methodist JC Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Barbara
authors.initials: B
authors.lastname: Elias
authors.affiliation: Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Erik E
authors.initials: EE
authors.lastname: Suarez
authors.affiliation: Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas; Houston Methodist JC Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Brian
authors.initials: B
authors.lastname: Bruckner
authors.affiliation: Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas; Houston Methodist JC Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Matthias
authors.initials: M
authors.lastname: Loebe
authors.affiliation: Department of Infectious Diseases, Houston Methodist, Houston, Texas.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Harris
authors.affiliation: Department of Neurological Surgery, Houston Methodist, Houston, Texas.
authors.forename: J Yi
authors.initials: JY
authors.lastname: Zhang
authors.affiliation: Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas; Cátedra de Cardiologia y Medicina Vascular, Tecnológico de Monterrey, Monterrey, México.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Torre-Amione
authors.affiliation: Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas; Houston Methodist JC Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Jerry D
authors.initials: JD
authors.lastname: Estep
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000175:diagnosis* / Q000401:mortality; D004866:Equipment Contamination; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects* / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011183:Postoperative Complications / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality
keywords: Left ventricular assist device; Pseudomonas aeruginosa; cerebrovascular accident; infection