Clinical manifestations and management of left ventricular assist device-associated infections

Juhsien Jodi C Nienaber, Shimon Kusne, Talha Riaz, Randall C. Walker, Larry M. Baddour, Alan J. Wright, Soon J. Park, Holenarasipur R. Vikram, Michael R. Keating, Francisco A. Arabia, Brian D. Lahr, M. Rizwan Sohail

Research output: Contribution to journalArticle

104 Citations (Scopus)

Abstract

Background. Infection is a serious complication of left ventricular assist device (LVAD) therapy. Published data regarding LVAD-associated infections (LVADIs) are limited by single-center experiences and use of nonstandardized definitions. Methods. We retrospectively reviewed 247 patients who underwent continuous-flow LVAD implantation from January 2005 to December 2011 at Mayo Clinic campuses in Minnesota, Arizona, and Florida. LVADIs were defined using the International Society for Heart and Lung Transplantation criteria. Results. We identified 101 episodes of LVADI in 78 patients (32%) from this cohort. Mean age (± standard deviation [SD]) was 57±15 years. The majority (94%) underwent Heartmate II implantation, with 62% LVADs placed as destination therapy. The most common type of LVADIs were driveline infections (47%), followed by bloodstream infections (24% VAD related, and 22% non-VAD related). The most common causative pathogens included grampositive cocci (45%), predominantly staphylococci, and nosocomial gram-negative bacilli (27%). Almost half (42%) of the patients were managed by chronic suppressive antimicrobial therapy. While 14% of the patients had intraoperative debridement, only 3 underwent complete LVAD removal. The average duration (±SD) of LVAD support was 1.5±1.0 years. At year 2 of follow-up, the cumulative incidence of all-cause mortality was estimated to be 43%. Conclusion. Clinical manifestations of LVADI vary on the basis of the type of infection and the causative pathogen. Mortality remained high despite combined medical and surgical intervention and chronic suppressive antimicrobial therapy. Based on clinical experiences, a management algorithm for LVADI is proposed to assist in the decision-making process.

Original languageEnglish (US)
Pages (from-to)1438-1448
Number of pages11
JournalClinical Infectious Diseases
Volume57
Issue number10
DOIs
StatePublished - Nov 15 2013

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Heart-Assist Devices
Infection
Device Removal
Mortality
Debridement
Therapeutics
Staphylococcus
Bacillus
Decision Making

Keywords

  • Device-related infections
  • Driveline infections
  • Endocarditis
  • Heart failure
  • LVAD

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

Cite this

Nienaber, J. J. C., Kusne, S., Riaz, T., Walker, R. C., Baddour, L. M., Wright, A. J., ... Sohail, M. R. (2013). Clinical manifestations and management of left ventricular assist device-associated infections. Clinical Infectious Diseases, 57(10), 1438-1448. https://doi.org/10.1093/cid/cit536

Clinical manifestations and management of left ventricular assist device-associated infections. / Nienaber, Juhsien Jodi C; Kusne, Shimon; Riaz, Talha; Walker, Randall C.; Baddour, Larry M.; Wright, Alan J.; Park, Soon J.; Vikram, Holenarasipur R.; Keating, Michael R.; Arabia, Francisco A.; Lahr, Brian D.; Sohail, M. Rizwan.

In: Clinical Infectious Diseases, Vol. 57, No. 10, 15.11.2013, p. 1438-1448.

Research output: Contribution to journalArticle

Nienaber, JJC, Kusne, S, Riaz, T, Walker, RC, Baddour, LM, Wright, AJ, Park, SJ, Vikram, HR, Keating, MR, Arabia, FA, Lahr, BD & Sohail, MR 2013, 'Clinical manifestations and management of left ventricular assist device-associated infections', Clinical Infectious Diseases, vol. 57, no. 10, pp. 1438-1448. https://doi.org/10.1093/cid/cit536
Nienaber JJC, Kusne S, Riaz T, Walker RC, Baddour LM, Wright AJ et al. Clinical manifestations and management of left ventricular assist device-associated infections. Clinical Infectious Diseases. 2013 Nov 15;57(10):1438-1448. https://doi.org/10.1093/cid/cit536
Nienaber, Juhsien Jodi C ; Kusne, Shimon ; Riaz, Talha ; Walker, Randall C. ; Baddour, Larry M. ; Wright, Alan J. ; Park, Soon J. ; Vikram, Holenarasipur R. ; Keating, Michael R. ; Arabia, Francisco A. ; Lahr, Brian D. ; Sohail, M. Rizwan. / Clinical manifestations and management of left ventricular assist device-associated infections. In: Clinical Infectious Diseases. 2013 ; Vol. 57, No. 10. pp. 1438-1448.
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abstract = "Background. Infection is a serious complication of left ventricular assist device (LVAD) therapy. Published data regarding LVAD-associated infections (LVADIs) are limited by single-center experiences and use of nonstandardized definitions. Methods. We retrospectively reviewed 247 patients who underwent continuous-flow LVAD implantation from January 2005 to December 2011 at Mayo Clinic campuses in Minnesota, Arizona, and Florida. LVADIs were defined using the International Society for Heart and Lung Transplantation criteria. Results. We identified 101 episodes of LVADI in 78 patients (32{\%}) from this cohort. Mean age (± standard deviation [SD]) was 57±15 years. The majority (94{\%}) underwent Heartmate II implantation, with 62{\%} LVADs placed as destination therapy. The most common type of LVADIs were driveline infections (47{\%}), followed by bloodstream infections (24{\%} VAD related, and 22{\%} non-VAD related). The most common causative pathogens included grampositive cocci (45{\%}), predominantly staphylococci, and nosocomial gram-negative bacilli (27{\%}). Almost half (42{\%}) of the patients were managed by chronic suppressive antimicrobial therapy. While 14{\%} of the patients had intraoperative debridement, only 3 underwent complete LVAD removal. The average duration (±SD) of LVAD support was 1.5±1.0 years. At year 2 of follow-up, the cumulative incidence of all-cause mortality was estimated to be 43{\%}. Conclusion. Clinical manifestations of LVADI vary on the basis of the type of infection and the causative pathogen. Mortality remained high despite combined medical and surgical intervention and chronic suppressive antimicrobial therapy. Based on clinical experiences, a management algorithm for LVADI is proposed to assist in the decision-making process.",
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