Division of Infectious Diseases, Department of Medicine, University of California, San Diego, La Jolla, California.
James and John Kirklin Institute for Research in Surgical Outcomes (KIRSO), Division of Cardiothoracic Surgery, Department of Surgery, The University of Alabama at Birmingham, Alabama.
J Heart Lung Transplant. 2018 Aug;37(8):1013-1020. doi: 10.1016/j.healun.2018.04.006. Epub 2018 Apr 25.
We used multicenter international data from the International Society of Heart and Lung Transplantation Mechanically Assisted Circulation Support (IMACS) registry to determine bloodstream infection (BSI) event rate, independent risk factors, and association with mortality.
Included were patients registered in IMACS from January 2013 through December 2015, assessed BSI event rate of mechanical circulatory support (MCS) and non-MCS-related BSIs, and conducted univariate and multivariate analyses between BSI with baseline characteristics and mortality.
We documented 1,606 BSIs in 1,231 of 10,171 MCS recipients (12%), with an event rate of 2.43 BSIs/100 patient-months within 3 months after implant (early onset) and 1.03 BSIs/100 patient-months after 3 months (late onset). Of these episodes, 1,378 (85.8%) were non- MCS-related BSI. Increasing body mass index and bilirubin were independent correlates of MCS-related BSI. Independent correlates of non-MCS-related BSI included older age, higher body mass index, previous cardiac surgery, baseline chronic renal disease and dialysis, pre-implant frailty, presence of biventricular assist device, total artificial heart or right ventricular assist device, and Interagency Registry for Mechanically Assisted Circulatory Support category 1. Survival after 3 months after implant of patients who developed early-onset BSI was 56.9% at 24 months vs 77.4% in patients without early-onset BSI (p < 0.001). Early-onset BSI was an independent correlate of mortality at 3 months after implantation (hazard ratio, 2.56; 95% confidence interval, 2.09-3.15; p < 0.001).
Early-onset BSI was associated with significantly increased 24-month mortality. More than 85% of these BSIs were not device related. There is an opportunity for infection prevention practices to decrease the BSI event rate, which may affect 24-month survival. These data can also serve as benchmarking for individual institutions.
我们利用国际心肺移植学会机械循环支持（IMACS）注册中心的多中心国际数据，确定血流感染（BSI）的发生率、独立危险因素以及与死亡率的关系。
纳入 2013 年 1 月至 2015 年 12 月期间在 IMACS 注册的患者，评估机械循环支持（MCS）和非-MCS 相关 BSI 的 BSI 发生率，并在基线特征和死亡率之间进行 BSI 的单变量和多变量分析。
我们记录了 10171 例 MCS 接受者中的 1231 例（12%）发生了 1606 例 BSI，植入后 3 个月内（早期发病）的 BSI 发生率为 2.43/100 患者-月，3 个月后（晚期发病）的 BSI 发生率为 1.03/100 患者-月。这些病例中，1378 例（85.8%）为非-MCS 相关 BSI。体重指数增加和胆红素升高是 MCS 相关 BSI 的独立相关因素。非-MCS 相关 BSI 的独立相关因素包括年龄较大、体重指数较高、既往心脏手术、基线慢性肾脏病和透析、植入前虚弱、存在双心室辅助装置、全人工心脏或右心室辅助装置和机构间机械循环支持注册分类 1。发生早期 BSI 的患者在植入后 3 个月的 24 个月生存率为 56.9%，而无早期 BSI 的患者为 77.4%（p <0.001）。早期 BSI 是植入后 3 个月死亡率的独立相关因素（危险比，2.56；95%置信区间，2.09-3.15；p <0.001）。
早期 BSI 与 24 个月死亡率显著增加相关。这些 BSI 中超过 85%与器械无关。感染预防措施有机会降低 BSI 发生率，这可能影响 24 个月生存率。这些数据也可以作为各机构的基准。
