Back to Search
Start Over
Prospective, multicenter study of ventricular assist device infections.
- Source :
-
Circulation [Circulation] 2013 Feb 12; Vol. 127 (6), pp. 691-702. Date of Electronic Publication: 2013 Jan 11. - Publication Year :
- 2013
-
Abstract
- Background: Ventricular assist devices (VADs) improve survival and quality of life in patients with advanced heart failure, but their use is frequently complicated by infection. There are limited data on the microbiology and epidemiology of these infections.<br />Methods and Results: One hundred fifty patients scheduled for VAD implantation were enrolled (2006-2008) at 11 US cardiac centers and followed prospectively until transplantation, explantation for recovery, death, or for 1 year. Eighty-six patients (57%) received HeartMate II devices. Data were collected on potential preoperative, intraoperative, and postoperative risk factors for infection. Clinical, laboratory, and microbiological data were collected for suspected infections and evaluated by an infectious diseases specialist. Thirty-three patients (22%) developed 34 VAD-related infections with an incidence rate of 0.10 per 100 person-days (95% confidence interval, 0.073-0.142). The median time to infection was 68 days. The driveline was the most commonly infected site (n=28); 18 (64%) were associated with invasive disease. Staphylococci were the most common pathogen (47%), but pseudomonas or other Gram-negative bacteria caused 32% of infections. A history of depression and elevated baseline serum creatinine were independent predictors of VAD infection (adjusted hazard ratio=2.8 [P=0.007] and 1.7 [P=0.023], respectively). The HeartMate II was not associated with a decreased risk of infection. VAD infection increased 1-year mortality (adjusted hazard ratio=5.6; P<0.0001).<br />Conclusions: This prospective, multicenter study demonstrates that infection frequently complicates VAD placement and is a continuing problem despite the use of newer, smaller devices. Depression and renal dysfunction may increase the risk of VAD infection. VAD infection is a serious consequence because it adversely affects patient survival.<br />Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01471795.
- Subjects :
- Adult
Aged
Cardiovascular Infections epidemiology
Cardiovascular Infections microbiology
Creatinine blood
Depression epidemiology
Female
Gram-Negative Bacterial Infections microbiology
Heart Failure therapy
Humans
Incidence
Male
Middle Aged
Risk Factors
Severity of Illness Index
Treatment Outcome
Gram-Negative Bacterial Infections epidemiology
Heart-Assist Devices microbiology
Prosthesis-Related Infections epidemiology
Prosthesis-Related Infections microbiology
Pseudomonas Infections epidemiology
Staphylococcal Infections epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1524-4539
- Volume :
- 127
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Circulation
- Publication Type :
- Academic Journal
- Accession number :
- 23315371
- Full Text :
- https://doi.org/10.1161/CIRCULATIONAHA.112.128132