Gordon S M, Schmitt S K, Jacobs M, Smedira N M, Goormastic M, Banbury M K, Yeager M, Serkey J, Hoercher K, McCarthy P M
Department of Infectious Disease, The Cleveland Clinic Foundation, Ohio, USA.
Ann Thorac Surg. 2001 Sep;72(3):725-30. doi: 10.1016/s0003-4975(01)02888-0.
Implantable left ventricular assist devices (LVAD) are used as a bridge to transplantation but are associated with a high risk of infection including nosocomial bloodstream infections (BSI).
We retrospectively reviewed the medical records of all patients with implantable LVAD at the Cleveland Clinic with 72 hours or longer of LVAD support from January 1992 through June 2000, to determine the attack rate, incidence, and impact of nosocomial BSI in patients with LVAD. A nosocomial BSI was defined using Centers for Disease Control and Prevention definition. An LVAD-related BSI was defined as one where the same pathogen is cultured from the device and the blood with no other obvious source. Two hundred fourteen patients were included in the study (17,831 LVAD-days).
One hundred forty BSI were identified in 104 patients for an attack rate of 49% and incidence of 7.9 BSI per 1000 LVAD-days. Thirty-eight percent of the BSI were LVAD associated. The most common pathogens causing BSI were coagulase-negative staphylococci (n = 33), Staphylococcus aureus, and Candida spp. (19 each), and Pseudomonas aeruginosa (16 each). A Cox proportional hazard model found BSI in patients with LVAD to be significantly associated with death (hazard ratio = 4.02, p < 0.001). Fungemia had the highest hazard ratio (10.9), followed by gram-negative bacteremia (5.1), and gram-positive bacteremia (2.2).
Patients with implantable LVAD have a high incidence of BSI, which are associated with a significantly increased mortality. Strategies for prevention of infection in LVAD recipients should focus on the drive line exit site until technical advances can achieve a totally implantable device.
可植入式左心室辅助装置（LVAD）被用作移植桥梁，但与包括医院血流感染（BSI）在内的高感染风险相关。
我们回顾性分析了1992年1月至2000年6月在克利夫兰诊所接受LVAD支持72小时或更长时间的所有可植入LVAD患者的病历，以确定LVAD患者医院BSI的发病率、发生率及影响。医院BSI采用疾病控制与预防中心的定义。LVAD相关BSI定义为从装置和血液中培养出相同病原体且无其他明显来源的情况。214例患者纳入研究（17831个LVAD日）。
104例患者中发现140例BSI，发病率为49%，每1000个LVAD日的发生率为7.9例BSI。38%的BSI与LVAD相关。引起BSI最常见的病原体是凝固酶阴性葡萄球菌（n = 33）、金黄色葡萄球菌、念珠菌属（各19例）和铜绿假单胞菌（各16例）。Cox比例风险模型发现LVAD患者的BSI与死亡显著相关（风险比 = 4.02，p < 0.001）。真菌血症的风险比最高（10.9），其次是革兰氏阴性菌血症（5.1）和革兰氏阳性菌血症（2.2）。
可植入LVAD患者的BSI发病率高，且与死亡率显著增加相关。在技术进步实现完全可植入装置之前，LVAD接受者的感染预防策略应侧重于驱动线出口部位。
