Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
J Investig Med. 2019 Mar;67(3):653-658. doi: 10.1136/jim-2018-000893. Epub 2019 Jan 29.
Bloodstream infections (BSIs) are common in patients with continuous-flow left ventricular assist devices (CF-LVADs). Whether CF-LVADs modulate the febrile response to BSIs is unknown. We retrospectively compared the febrile response to BSIs in patients with heart failure (HF) with CF-LVADs versus a control population of patients with HF receiving inotropic infusions. BSIs were adjudicated using the Centers for Disease Control and Prevention and the National Healthcare Safety Network criteria. Febrile status (temperature ≥38°C, 100.4 °F), temperature at presentation with BSI, and the highest temperature within 72 hours (Tmax) were collected. We observed 59 BSIs in LVAD patients and 45 BSIs in controls. LVAD patients were more likely to be afebrile and to have a lower temperature at presentation than control (88% vs 58%, p=0.002, and 37°C ±0.7 vs 37.7°C ±1.0, p=0.0009, respectively). By 72 hours, the difference in afebrile status diminished (53% vs 44%, p=0.42), and the Tmax was similar between the LVAD and control groups (37.9°C±0.9 vs 38.2°C±0.8, respectively, p=0.10). In conclusion, at presentation with a BSI, the vast majority of CF-LVAD patients were afebrile, an event which occurred at a higher frequency when compared with patients with advanced HF on chronic inotropes via an indwelling venous catheter. These data alert clinicians to have a very low threshold to obtain blood cultures in CF-LVAD patients even in the absence of fever. Further study is needed to determine whether a delayed or diminished febrile response represents another pathophysiological consequence of CF-LVADs.
血流感染（BSI）在持续性左心室辅助装置（CF-LVAD）患者中很常见。CF-LVAD 是否调节 BSI 的发热反应尚不清楚。我们回顾性比较了心力衰竭（HF）伴 CF-LVAD 患者与接受正性肌力输注的 HF 对照人群中 BSI 的发热反应。BSI 的判定采用美国疾病控制与预防中心和国家医疗保健安全网络的标准。收集发热状态（体温≥38°C，100.4°F）、BSI 时的体温和 72 小时内的最高体温（Tmax）。我们观察到 LVAD 患者 59 例 BSI 和对照组 45 例 BSI。LVAD 患者发热的可能性较低，且发热的体温也低于对照组（88% vs 58%，p=0.002，和 37°C±0.7 vs 37.7°C±1.0，p=0.0009）。72 小时后，发热状态的差异减小（53% vs 44%，p=0.42），LVAD 和对照组的 Tmax 相似（37.9°C±0.9 vs 38.2°C±0.8，p=0.10）。总之，在出现 BSI 时，绝大多数 CF-LVAD 患者无发热，与通过留置静脉导管接受慢性正性肌力药物的晚期 HF 患者相比，这种情况发生的频率更高。这些数据提醒临床医生，即使没有发热，也应非常低的阈值在 CF-LVAD 患者中获得血培养。需要进一步研究以确定延迟或减弱的发热反应是否代表 CF-LVAD 的另一种病理生理后果。
