Pediatric Cardiac Anesthesia/Intensive Care Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
Artif Organs. 2011 Nov;35(11):1110-4. doi: 10.1111/j.1525-1594.2011.01389.x.
During the last decade, ventricular assist devices (VADs) have become a precious tool to support children with end-stage heart failure. However, thromboembolic events, bleeding, and infections may have a considerable impact on outcome. We retrospectively analyzed the incidence of healthcare-associated infections (HAIs) in nine patients supported by EXCOR Pediatric (Berlin Heart [BH]) VAD in a pediatric cardiosurgical intensive care unit between January 1, 2009 and March 31, 2011 (27 months). Median age was 8 months (interquartile range [IQR] 6-11), median weight 7.5 kg (IQR 4.5-8.5). Seven patients were supported with a left VAD, two with a biventricular VAD (BiVAD). Six patients with a left VAD underwent heart transplant after 89 days (median, IQR 41-143) of support. One patient is still on the waiting list. All patients with BiVAD died after 12 days of assistance due to VAD malfunction. Sixteen HAIs were reported in five out of nine patients (56%). All infected patients were supported by a left VAD. When compared with noninfected patients, they had a longer mechanical support period (median 131 days, IQR 75-164, vs. 25 days, IQR 11-61, P = 0.03), a longer intensive care unit stay (median 159 days, IQR 85-188, vs. 48 days, IQR 17-87, P = 0.06) and a longer length of hospital stay (median 186 days, IQR 105-222, vs. 64 days, IQR 34-113, P = 0.06). Overall, nine mechanical devices were replaced for thromboembolic issues, most of them (67%) in patients with VAD-related infections. Overall, infection rate was 17.6 per 1000 patients days, 1.3 BH endocarditis per 1000 BH days, 4.0 surgical sites infections per 1000 BH days, 12.5 central line-associated blood stream infections per 1000 central venous catheter days, 5 catheter-associated urinary tract infections per 1000 urinary catheter days, and 13.5 ventilator-associated pneumonia cases per 1000 mechanical ventilation days. Overall, VAD-related infections were 5.4 per 1000 BH days. Of the 17 isolated pathogens, 53% were Gram-negative rods, with a prevalence of Pseudomonas aeruginosa (35.3%). Four bacteria were multidrug resistant (25%), three were carbapenem-resistant P. aeruginosa (50% of all isolated pseudomonads), and one was a methicillin-resistant S. aureus. VADs used as a bridge to cardiac transplantation are associated with a large number of HAIs. Patients with infected VADs were admitted for longer time in intensive care and in hospital with increased healthcare costs but with no impact on survival.
在过去的十年中，心室辅助装置（VAD）已成为支持终末期心力衰竭儿童的宝贵工具。然而，血栓栓塞事件、出血和感染可能对预后有重大影响。我们回顾性分析了 2009 年 1 月 1 日至 2011 年 3 月 31 日（27 个月）期间在儿科心脏外科重症监护病房接受柏林心脏（BH）EXCOR 小儿 VAD 支持的 9 例患者中发生的医疗保健相关性感染（HAI）的发生率。中位年龄为 8 个月（四分位距[IQR] 6-11），中位体重为 7.5 公斤（IQR 4.5-8.5）。7 例患者采用左 VAD 支持，2 例采用双心室 VAD（BiVAD）支持。6 例左 VAD 患者在支持 89 天后（中位，IQR 41-143）进行心脏移植。1 例患者仍在等待名单上。由于 VAD 故障，所有使用 BiVAD 的患者在 12 天后死亡。在 9 例患者中的 5 例（56%）报告了 16 例 HAI。所有感染患者均由左 VAD 支持。与未感染患者相比，他们的机械支持时间更长（中位数 131 天，IQR 75-164，与 25 天，IQR 11-61，P = 0.03），重症监护病房停留时间更长（中位数 159 天，IQR 85-188，与 48 天，IQR 17-87，P = 0.06）和住院时间更长（中位数 186 天，IQR 105-222，与 64 天，IQR 34-113，P = 0.06）。总体而言，9 个机械装置因血栓栓塞问题而更换，其中大多数（67%）在与 VAD 相关的感染患者中更换。总体而言，感染率为每 1000 个患者天 17.6 例，每 1000 个 BH 天 1.3 例 BH 心内膜炎，每 1000 个 BH 天 4.0 例手术部位感染，每 1000 个 BH 天 12.5 例中心静脉导管相关血流感染，每 1000 个导尿管天 5 例导尿管相关尿路感染，每 1000 个机械通气天 13.5 例呼吸机相关性肺炎病例。总体而言，VAD 相关感染每 1000 BH 天发生 5.4 次。在分离的 17 种病原体中，53%为革兰氏阴性杆菌，以铜绿假单胞菌（35.3%）为主。4 种细菌为多药耐药（25%），3 种为耐碳青霉烯类铜绿假单胞菌（所有分离的假单胞菌的 50%），1 种为耐甲氧西林金黄色葡萄球菌。用作心脏移植桥接的 VAD 与大量 HAIs 相关。感染 VAD 的患者在重症监护室和医院的住院时间更长，医疗保健费用增加，但对生存率没有影响。
