Department of Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France.
Department of Cardio-Thoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France.
Clin Microbiol Infect. 2017 Oct;23(10):748-751. doi: 10.1016/j.cmi.2017.03.008. Epub 2017 Mar 18.
The implantable left ventricular assist device (LVAD) is a major therapeutic development for end-stage heart failure in selected patients. As their use is expanding, infectious complications are emerging, with limited data available to guide their management. We aimed to better characterize LVAD-related infections.
We enrolled all consecutive patients diagnosed with LVAD-related infections in three referral centres in France, using a standardized definition of infections in patients with LVAD. Data were collected from medical charts using a standardized questionnaire.
Between 2007 and 2012, 159 patients received LVAD for end-stage heart failure. Among them, 36 (22.6%; 5 women, 31 men) presented at least one infectious complication, after a median time of 2.9 months from LVAD implantation (interquartile range, 1.8-7.5), with a median follow up of 12 months (interquartile range 8-17). Main co-morbidities were alcoholism (33%), diabetes (11%) and immunosuppression (11%). Mean age at implantation was 51 (±11) years. LVAD were implanted as bridge-to-transplantation (n=22), bridge-to-recovery (n=8), destination therapy (n=4), or unspecified (n=2). LVAD-related infections were restricted to the driveline exit site (n=17), had loco-regional extension (n=13), or reached the internal pump (n=3). The main bacteria isolated were Staphylococcus aureus (n=20), coagulase-negative staphylococci (n=7), Enterobacteriaceae (n=14), Pseudomonas aeruginosa (n=10) and Corynebacterium sp. (n=7), with polymicrobial infections in 19 cases. LVAD could be retained in all patients, with the use of prolonged antibacterial treatment in 34 (94%), and debridement in 17 (47%). One patient died due to LVAD-associated infection.
LVAD-related infections are common after LVAD implantation, and may be controlled by prolonged antibiotic treatment.
植入式左心室辅助装置（LVAD）是为选定患者的终末期心力衰竭提供的一种主要治疗方法。随着其应用的不断扩大，感染并发症不断出现，目前可用的数据有限，难以指导其治疗。本研究旨在更好地描述与 LVAD 相关的感染。
我们采用 LVAD 感染患者的标准化定义，在法国的三个转诊中心纳入所有连续诊断为与 LVAD 相关感染的患者。使用标准化问卷从病历中收集数据。
2007 年至 2012 年期间，159 例患者因终末期心力衰竭接受 LVAD 治疗。其中 36 例（22.6%；5 名女性，31 名男性）至少发生了一次感染并发症，中位时间为 LVAD 植入后 2.9 个月（四分位距，1.8-7.5），中位随访时间为 12 个月（四分位距，8-17）。主要合并症为酒精中毒（33%）、糖尿病（11%）和免疫抑制（11%）。植入时的平均年龄为 51（±11）岁。LVAD 被植入作为桥接移植（n=22）、桥接恢复（n=8）、终末期治疗（n=4）或未特指（n=2）。LVAD 相关感染仅限于驱动线出口部位（n=17）、具有局部扩展（n=13）或到达内部泵（n=3）。主要分离的细菌包括金黄色葡萄球菌（n=20）、凝固酶阴性葡萄球菌（n=7）、肠杆菌科（n=14）、铜绿假单胞菌（n=10）和棒状杆菌属（n=7），19 例为混合感染。所有患者均保留了 LVAD，34 例（94%）患者使用了延长的抗菌治疗，17 例（47%）患者进行了清创术。1 例患者因 LVAD 相关感染死亡。
LVAD 植入后，LVAD 相关感染很常见，但可通过延长抗生素治疗来控制。
