Journal article
Bloodstream Infections in Continuous Flow Left Ventricular Assist Device Recipients: Diagnostic and Clinical Implications
ASAIO journal (1992), v 65(8), pp 798-805
01 Nov 2019
PMID: 30234503
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Bloodstream infection (BSI) is a common complication of left ventricular assist device (LVAD) support and particularly difficult to treat. The presentation is often variable because of altered physiology and augmentation of cardiac output by the device. We studied LVAD recipients at a single institution. Multivariate logistic and Cox (with time-varying parameters) regression were implemented. Of 212 patients, 58% experienced infections. Driveline infection (DLI) affected 31%, with 60% of them having deep-tissue involvement. Sixty-six patients (31%) suffered from 135 BSIs. Systemic inflammatory response syndrome (SIRS) was present in 47% of BSIs at presentation and associated with increased mortality. Right heart failure, destination therapy, Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile, morbid obesity, and deep-DLI were independent risk factors for BSI. The BSI was independently associated with mortality. Bridge-to-transplantation (BTT) patients were more likely to receive transplant if they did not have BSIs. Among 104 BTT patients who received heart transplantation, development of BSI was associated with shorter time-to-transplantation. Diagnosis of BSI poses diagnostic and prognostic challenges because of the hemodynamic profile of LVAD patients who may not mount the expected physiologic response to sepsis. Although SIRS criteria lack sensitivity in the LVAD population, SIRS signifies increased risk for death. Deep DLI was the strongest predictor of BSI. Despite the upgrade in listing status of BTT-LVADs with BSIs and shorter time-to-transplantation, BSI remain a major cause of mortality. BSIs are associated with significant mortality and should be regarded as a serious complication, similar to pump thrombosis and stroke.
Metrics
Details
- Title
- Bloodstream Infections in Continuous Flow Left Ventricular Assist Device Recipients: Diagnostic and Clinical Implications
- Creators
- Andreas Kyvernitakis - Allegheny Gen Hosp, Dept Cardiovasc Dis, Pittsburgh, PA 15212 USAOrestis Pappas - Allegheny Gen Hosp, Dept Cardiovasc Dis, Pittsburgh, PA 15212 USADimitrios Farmakiotis - Brown UniversityEdward T. Horn - Allegheny Gen Hosp, Dept Pharm, Pittsburgh, PA 15212 USARaymond L. Benza - Allegheny Gen Hosp, Dept Cardiovasc Dis, Pittsburgh, PA 15212 USAStephen H. Bailey - Allegheny General HospitalRicha Agarwal - Allegheny Gen Hosp, Dept Cardiovasc Dis, Pittsburgh, PA 15212 USA
- Publication Details
- ASAIO journal (1992), v 65(8), pp 798-805
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 8
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Cardiothoracic Surgery
- Web of Science ID
- WOS:000494810400015
- Scopus ID
- 2-s2.0-85072267034
- Other Identifier
- 991021960653504721
UN Sustainable Development Goals (SDGs)
This publication has contributed to the advancement of the following goals:
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Engineering, Biomedical
- Transplantation