Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Australia.
Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Australia.
Heart Lung Circ. 2014 Mar;23(3):234-41. doi: 10.1016/j.hlc.2013.09.008. Epub 2013 Oct 18.
Ventricular assist device (VAD) implantation has become an effective option for patients with severe heart failure. However, device-related infections remain a significant problem. The aim of this study was to describe the incidence and microbiological aetiology of bacteraemia in patients with VADs, and to assess the impact of bacteraemia on clinical outcomes.
A retrospective study was conducted of patients having VAD implantation at the Alfred Hospital (Melbourne, Australia) from October 1990 to July 2009. Medical records and microbiology databases were reviewed. Patients who were supported with a VAD for 72h or more were evaluated for demographic data, VAD type, the occurrence of bacteraemia and clinical outcomes.
During the 19-year period, 135 VAD patients (89 Thoratec PVAD, 10 Novacor, and 36 Ventrassist) supported for a total duration of 17,304 (median 74) support days were included. Sixty-one patients (45%) developed VAD-associated bacteraemia, an incidence of 5.6 episodes per 1000 support days. The incidence of bacteraemia per 1000 days of support was similar for the three devices used: Thoratec PVAD, Novacor and Ventrassist VADs (7.8±0.8, 5.2±1.5 and 3.4±0.5, respectively, p=0.74). Staphylococcus aureus was the most common pathogen (25%). The rates of death on device, survival to transplant, recovery with explant and outcomes after transplantation, including 30-day mortality, median survival time and incidence of cerebrovascular accidents were not significantly impacted upon by bacteraemia.
Bacteraemia is common in VAD patients. However, the incidence of VAD-associated bacteraemia is independent of device type and with aggressive antimicrobial therapy; clinical outcomes need not be affected by the bacteraemia.
心室辅助装置（VAD）的植入已成为严重心力衰竭患者的有效选择。然而，与装置相关的感染仍然是一个重大问题。本研究的目的是描述 VAD 患者菌血症的发生率和微生物病因，并评估菌血症对临床结局的影响。
对 1990 年 10 月至 2009 年 7 月在澳大利亚墨尔本阿尔弗雷德医院植入 VAD 的患者进行了回顾性研究。查阅了病历和微生物数据库。对接受 VAD 支持 72 小时或以上的患者进行了人口统计学数据、VAD 类型、菌血症发生和临床结局的评估。
在 19 年期间，共纳入了 135 例 VAD 患者（89 例 Thoratec PVAD、10 例 Novacor 和 36 例 Ventrassist），总支持时间为 17304 天（中位数为 74 天）。61 例（45%）患者发生了与 VAD 相关的菌血症，每 1000 天支持的发生率为 5.6 例。三种装置的菌血症发生率相似：Thoratec PVAD、Novacor 和 Ventrassist VAD 分别为 7.8±0.8、5.2±1.5 和 3.4±0.5，差异无统计学意义（p=0.74）。金黄色葡萄球菌是最常见的病原体（25%）。死亡率、移植存活率、撤机存活率和移植后结局（包括 30 天死亡率、中位生存时间和脑血管意外发生率）不受菌血症的影响。
VAD 患者菌血症很常见。然而，VAD 相关菌血症的发生率与装置类型无关，通过积极的抗菌治疗，临床结局不一定会受到菌血症的影响。
