AI Article Synopsis
- VAD infections are a common and serious complication in patients receiving left ventricular assist devices, with a notable incidence of 36.9 cases per 100 person-years during a study involving 455 patients.
- Driveline infections were the most prevalent, with gram-positive bacteria being the leading cause; however, standard clinical and imaging assessments often failed to predict the severity of these infections.
- Patients with infections specifically related to the VAD had a significantly lower median survival (14 months) compared to those with VAD-related infections (35 months), highlighting the need for better diagnostic practices and treatment strategies.
Article Abstract
Background: Infection is a major complication during circulatory support with a left ventricular assist device (VAD). Changes in device characteristics and treatment practices in the last decade can affect the epidemiology of infection. The International Society for Heart and Lung Transplantation (ISHLT) has published recommendations on the prevention and management of VAD infections, but data to support these recommendations remain sparse.
Methods: We performed a retrospective review of 455 patients who underwent VAD placement from 2009 to 2015. Infection episodes were defined using ISHLT criteria and were also grouped as endovascular or local. Analysis included descriptive statistics.
Results: There were 174 patients (38.6%) with a VAD infection. Infection incidence was 36.9 cases per 100 person-years of VAD support. The driveline was the most common infection site (67.2%). Systemic inflammatory response syndrome (SIRS) criteria were not satisfied in 29.2% of patients with endovascular infections, and computed tomography (CT) examinations were normal in 37.7% of cases. Gram-positive bacteria caused 65.6% of infections in patients with an available culture. Antimicrobial suppression was used in 72.3% of patients who survived treatment. Median survival after infection was 35 months for patients with VAD-related infections versus 14 months for patients with VAD-specific infections.
Conclusions: VAD infections continue to be a major complication after implantation. Clinical criteria alone were not predictive of serious infections, and many patients with confirmed infection had normal CTs. Patients with VAD-specific infections had lower median survival than patients with VAD-related infections.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7982342 | PMC |
| http://dx.doi.org/10.1093/cid/ciaa011 | DOI Listing |
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