Hieda M, Sata M, Seguchi O, Yanase M, Murata Y, Sato T, Sunami H, Nakajima S, Watanabe T, Hori Y, Wada K, Hata H, Fujita T, Kobayashi J, Nakatani T
Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
Department of Pulmonology and Infection Control, National Cerebral and Cardiovascular Center, Osaka, Japan.
Transplant Proc. 2014 Apr;46(3):907-10. doi: 10.1016/j.transproceed.2013.11.106.
A left ventricular assist device (LVAD) is essential for treating patients with advanced heart failure. However, LVAD-related infection is a significant cause of mortality and morbidity, with bloodstream infection (BSI) especially associated with high mortality. We investigated the incidence of infectious complications in patients who received an LVAD and evaluated the effects of early and appropriate intervention for LVAD-related infection.
We retrospectively reviewed 27 consecutive patients who underwent continuous-flow LVAD (CF-LVAD; n = 16) or pulsatile-flow LVAD (PF-LVAD; n = 11) implantation at the National Cerebral and Cardiovascular Center between April 2011 and March 2013. Incidences of LVAD-related infections, such as drive-line infection in patients with CF-LVAD, cannula infection in patients with PF-LVAD, and BSI in patients with both types, were examined (follow-up period, 342 ± 229 days). The mandatory antibiotic prophylaxis protocol at our institution includes teicoplanin (400 mg) 2 days before LVAD implantation and doripenem (1000 mg) within 1 hour of skin incision. In addition, the driveline exit sites undergo sterile cleansing with diluted hydrogen peroxide and placement of an antimicrobial occlusive dressing for wound care, with dressing changes performed 2-3 times per day.
More than 90% of all patients suffered from a drive-line infection within 12 months after LVAD implantation. However, BSI developed in only 12.5% of CF-LVAD and 10% of PF-LVAD patients within 12 months (log-rank test; P = .875).
LVAD-related infections, such as drive-line and cannula infections, were common, whereas the incidence of BSI was low in our LVAD-implanted patients. Our results highlight the importance of early and appropriate intervention including antibiotics and wound care for device-related infections for reducing the incidence of potentially fatal BSI.
左心室辅助装置（LVAD）对于治疗晚期心力衰竭患者至关重要。然而，LVAD相关感染是导致死亡率和发病率的重要原因，血流感染（BSI）尤其与高死亡率相关。我们调查了接受LVAD治疗的患者感染并发症的发生率，并评估了对LVAD相关感染进行早期和适当干预的效果。
我们回顾性分析了2011年4月至2013年3月期间在国立脑神经与心血管中心连续接受连续流LVAD（CF-LVAD；n = 16）或搏动流LVAD（PF-LVAD；n = 11）植入的27例患者。检查了LVAD相关感染的发生率，如CF-LVAD患者的驱动线感染、PF-LVAD患者的插管感染以及两种类型患者的BSI（随访期为342±229天）。我们机构的强制性抗生素预防方案包括在LVAD植入前2天使用替考拉宁（400mg）以及在皮肤切开后1小时内使用多利培南（1000mg）。此外，驱动线出口部位用稀释的过氧化氢进行无菌清洁，并放置抗菌封闭敷料进行伤口护理，每天更换敷料2 - 3次。
超过90%的患者在LVAD植入后12个月内发生了驱动线感染。然而，在12个月内，只有12.5%的CF-LVAD患者和10%的PF-LVAD患者发生了BSI（对数秩检验；P = 0.875）。
LVAD相关感染，如驱动线和插管感染很常见，而在我们接受LVAD植入的患者中BSI的发生率较低。我们的结果强调了早期和适当干预（包括抗生素和伤口护理）对于减少潜在致命性BSI发生率的设备相关感染的重要性。
