title: Multidrug-Resistant Organism Infections in Patients with Left Ventricular Assist Devices.
abstract: Left ventricular assist devices improve survival prospects in patients with end-stage heart failure; however, infection complicates up to 59% of implantation cases. How many of these infections are caused by multidrug-resistant organisms is unknown. We sought to identify the incidence, risk factors, and outcomes of multidrug-resistant organism infection in patients who have left ventricular assist devices. We retrospectively evaluated the incidence of multidrug-resistant organisms and the independent risk factors associated with them in 57 patients who had permanent left ventricular assist devices implanted at our institution from May 2007 through October 2011. Outcomes included death, transplantation, device explantation, number of subsequent hospital admissions, and number of subsequent admissions related to infection. Infections were categorized in accordance with criteria from the Infectious Diseases Council of the International Society for Heart and Lung Transplantation. Multidrug-resistant organism infections developed in 18 of 57 patients (31.6%)-a high incidence. We found 3 independent risk factors: therapeutic goal (destination therapy vs bridging), P=0.01; body mass index, P=0.04; and exposed velour at driveline exit sites, P=0.004. We found no significant differences in mortality, transplantation, or device explantation rates; however, there was a statistically significant increase in postimplantation hospital admissions in patients with multidrug-resistant organism infection. To our knowledge, this is the first report in the medical literature concerning multidrug-resistant organism infection in patients who have permanent left ventricular assist devices.
authors.forename: Elisabeth E
authors.initials: EE
authors.lastname: Donahey
authors.forename: Derek M
authors.initials: DM
authors.lastname: Polly
authors.forename: J David
authors.initials: JD
authors.lastname: Vega
authors.forename: Marshall
authors.initials: M
authors.lastname: Lyon
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.forename: Duc
authors.initials: D
authors.lastname: Nguyen
authors.forename: Ann
authors.initials: A
authors.lastname: Pekarek
authors.forename: Kristin
authors.initials: K
authors.lastname: Wittersheim
authors.forename: Patrick
authors.initials: P
authors.lastname: Kilgo
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Paciullo
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D015992:Body Mass Index; D020878:Device Removal; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D000900:Anti-Bacterial Agents
keywords: Cross-infection/etiology/prevention & control; drug resistance, multiple/bacterial; heart failure/therapy; heart-assist devices/adverse effects/microbiology; postoperative complications; prosthesis-related infections/diagnosis/microbiology; retrospective studies; risk factors; ventricular dysfunction, left/therapy