Left ventricular assist device-related infections: a multicentric study.
OBJECTIVE
The implantable left ventricular assist device (LVAD) is a major therapeutic development for end-stage heart failure in selected patients. As their use is expanding, infectious complications are emerging, with limited data available to guide their management. We aimed to better characterize LVAD-related infections.


METHODS
We enrolled all consecutive patients diagnosed with LVAD-related infections in three referral centres in France, using a standardized definition of infections in patients with LVAD. Data were collected from medical charts using a standardized questionnaire.


RESULTS
Between 2007 and 2012, 159 patients received LVAD for end-stage heart failure. Among them, 36 (22.6%; 5 women, 31 men) presented at least one infectious complication, after a median time of 2.9 months from LVAD implantation (interquartile range, 1.8-7.5), with a median follow up of 12 months (interquartile range 8-17). Main co-morbidities were alcoholism (33%), diabetes (11%) and immunosuppression (11%). Mean age at implantation was 51 (±11) years. LVAD were implanted as bridge-to-transplantation (n=22), bridge-to-recovery (n=8), destination therapy (n=4), or unspecified (n=2). LVAD-related infections were restricted to the driveline exit site (n=17), had loco-regional extension (n=13), or reached the internal pump (n=3). The main bacteria isolated were Staphylococcus aureus (n=20), coagulase-negative staphylococci (n=7), Enterobacteriaceae (n=14), Pseudomonas aeruginosa (n=10) and Corynebacterium sp. (n=7), with polymicrobial infections in 19 cases. LVAD could be retained in all patients, with the use of prolonged antibacterial treatment in 34 (94%), and debridement in 17 (47%). One patient died due to LVAD-associated infection.


CONCLUSIONS
LVAD-related infections are common after LVAD implantation, and may be controlled by prolonged antibiotic treatment.
Department of Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France.
S
S
Siméon
Department of Cardio-Thoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France.
E
E
Flécher
Department of Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France; Inserm U835, Rennes-1 University, France.
M
M
Revest
Anaesthesiology Department, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie, Assistance Publique des Hôpitaux de Paris, France.
M
M
Niculescu
Department of Cardio-Thoracic and Vascular Surgery, Thorax Institute, Laennec University Hospital, Nantes, France.
J-C
JC
Roussel
Department of Cardiovascular Diseases, Laennec University Hospital, Nantes, France.
M
M
Michel
Surgery Department, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie, Assistance Publique des Hôpitaux de Paris, France.
P
P
Leprince
Department of Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France; Inserm U835, Rennes-1 University, France. Electronic address: pierre.tattevin@chu-rennes.fr.
P
P
Tattevin
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D060085:Coinfection / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D003646:Debridement; D005260:Female; D005602:France / Q000453:epidemiology; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents
Foreign device; Staphylococcus aureus; heart failure; heart transplant; left ventricular assist device