LVADI management depends on pathogen, infection type
The type of infection and the causative pathogen played roles in the clinical manifestation of left ventricular assist device-associated infections, researchers from the Mayo Cardiovascular Infections Study Group have found.
“Infection is a major complication associated with [left ventricular assist device] therapy, with reported rates ranging from 25% to 80%,” the researchers wrote in Clinical Infectious Diseases. “Prior publications that examined different aspects of [left ventricular assist device] infections have significant limitations in methodology, have small sample sizes, or focused on outdated first-generation pulsatile flow [left ventricular assist devices].”
The researchers conducted a retrospective study that included 247 patients who received continuous-flow left ventricular assist devices (LVADs) at any of the Mayo Clinic campuses from 2005 to 2011. They classified LVAD-associated infections (LVADIs) according to the International Society for Heart and Lung Transplantation criteria.
There were 101 LVADIs in 78 patients. The overall incidence was 32.8 per 100 person-years. The most common LVADI was driveline infection, comprising 47% of the infections. Bloodstream infections (24% VAD-related and 22% non–VAD-related) were the second most common. The most common pathogens included gram-positive cocci, which comprised 45% of the infections, and nosocomial gram-negative bacilli, with 27% of the infections.
Most patients were treated without surgical intervention, but 13% of patients underwent intraoperative debridement with device retention. Three patients had their devices completely removed. The median antimicrobial therapy was 28 days, and patients with local infections were more likely to receive oral antibiotics. Thirteen patients had one or more relapses of LVADI.
“Clinical manifestations and management of LVADI vary based on the extent of infection and causative pathogens,” the researchers wrote. “Understanding these differences is critical in making timely diagnosis and providing appropriate management interventions. Future analysis looking at clinical predictors for LVADI and mortality in LVAD patients will provide further insight into the management of LVADI.”
Disclosure: The researchers report no relevant financial disclosures.