Intensive Care Unit, The Prince Charles Hospital, Brisbane, Qld, Australia.
Intensive Care Unit, The Prince Charles Hospital, Brisbane, Qld, Australia.
Heart Lung Circ. 2020 Aug;29(8):1234-1240. doi: 10.1016/j.hlc.2020.02.002. Epub 2020 Mar 6.
Ventricular assist devices (VADs) are frequently used as a bridge to heart transplant; however, infections are a common cause of increased morbidity and mortality. The optimal prophylactic antimicrobial regimen has not been effectively evaluated in literature.
Forty-three (43) patients received a VAD over the 5-year study period (2012-2017) at The Prince Charles Hospital (TPCH), Brisbane Australia. Of these, 41 patients were followed from implantation until transplantation or death. Antimicrobial prophylactic regimens and individual episodes of infection were recorded. The infection profiles, including types and incidence were compared to published literature using definitions from the International Society for Heart and Lung Transplantation (ISHLT) guidelines for consistency.
Median duration of VAD insertion was 79 days (IQR: 36-167). Patients received aztreonam, fluconazole and vancomycin (median duration 8 days). Twenty-two (22) (53.6%) patients experienced a VAD-specific and/or a VAD-related infective episode. Incidence of infection in the study cohort was 0.60 infections per 100 patient days. Thirteen (13) patients (31.7%) experienced 16 VAD-specific infections which were all driveline infections. Thirteen (13) patients (31.7%) experienced 14 VAD-related infections. The predominant VAD-related infection type was bacteraemia (36%). Predominant bacterial profiles of VAD-specific as well as VAD related infections were gram positive. Only three episodes had a gram negative as a causative pathogen which occurred much later post VAD insertion. Median time till VAD-specific or VAD-related infection was 46 and 15 days respectively. Obesity was significantly associated with increased risk of infection (HR: 3.2; 95% CI: 1.3-7.4).
Infection is a common complication of VAD implantation. In our study population gram positive bacteria were the predominant causative pathogen. Based on the micro-organism profile there may be scope for a narrowing of the antibiotic regimen. A larger, multicentre study would be able to accurately guide a change. The information gathered in our study offers a strong foundation for such a multicentre study.
心室辅助装置（VAD）常被用作心脏移植的桥接治疗；然而，感染是导致发病率和死亡率增加的常见原因。文献中尚未有效评估最佳的预防性抗菌治疗方案。
在澳大利亚布里斯班的王子查尔斯医院（TPCH），在 5 年的研究期间（2012-2017 年），共有 43 名患者接受了 VAD。其中，41 名患者从植入到移植或死亡都接受了随访。记录了抗菌预防方案和个别感染事件。使用国际心肺移植协会（ISHLT）指南中的定义，将感染谱（包括类型和发生率）与文献进行比较，以保持一致性。
VAD 插入的中位时间为 79 天（IQR：36-167）。患者接受了氨曲南、氟康唑和万古霉素（中位时间为 8 天）。22（22）名（53.6%）患者发生了 VAD 特异性和/或 VAD 相关感染。研究队列的感染发生率为每 100 患者天 0.60 次感染。13 名（13）名患者（31.7%）发生了 16 次 VAD 特异性感染，均为导管相关感染。13 名（13）名患者（31.7%）发生了 14 次 VAD 相关感染。VAD 相关感染的主要类型是菌血症（36%）。VAD 特异性和 VAD 相关感染的主要细菌谱均为革兰阳性菌。只有 3 次感染的病原体是革兰氏阴性菌，发生在 VAD 植入后很久。VAD 特异性或 VAD 相关感染的中位时间分别为 46 天和 15 天。肥胖与感染风险增加显著相关（HR：3.2；95%CI：1.3-7.4）。
感染是 VAD 植入的常见并发症。在我们的研究人群中，革兰氏阳性菌是主要的病原体。根据微生物谱，抗生素方案可能会有所缩小。一项更大的多中心研究将能够准确指导这种改变。我们的研究收集的信息为这样的多中心研究提供了坚实的基础。
