Radcliffe Christopher, Doilicho Natnael, Grant Matthew
Yale School of Medicine, New Haven, Connecticut.
Department of Internal Medicine, Section of Infectious Diseases, Yale New Haven Hospital, New Haven, Connecticut.
J Card Surg. 2020 May;35(5):1138-1141. doi: 10.1111/jocs.14530. Epub 2020 Apr 6.
Left ventricular assist devices (LVADs) are integral for the management of medically refractory heart failure, and LVAD infections are common following device placement. Most infections are caused by Staphylococcal spp. and Gram-negative enteric bacteria but nontuberculous mycobacterial (NTM) infections have been reported. We present the second-ever reported case of a driveline infection caused by Mycobacterium fortuitum in a 75-year-old male with a continuous-flow LVAD. After receiving meropenem, azithromycin, and ciprofloxacin, he underwent device exchange and ultimately died after failing to recover neurologically. Management of NTM infections presents a clinical challenge due to the propensity for rapidly growing mycobacterial species to form biofilms and the possibility of negative cultures delaying diagnosis. To address the literature gap surrounding NTM infections in LVAD patients, we performed a systematic review and present all previously reported cases.
左心室辅助装置（LVADs）是治疗难治性心力衰竭不可或缺的手段，LVAD植入后感染很常见。大多数感染由葡萄球菌属和革兰氏阴性肠道细菌引起，但非结核分枝杆菌（NTM）感染也有报道。我们报告了第二例由偶然分枝杆菌引起的75岁男性连续血流LVAD患者的导线感染病例。在接受美罗培南、阿奇霉素和环丙沙星治疗后，他接受了装置更换，最终因神经功能未能恢复而死亡。由于快速生长的分枝杆菌物种易于形成生物膜以及阴性培养可能延迟诊断，NTM感染的管理面临临床挑战。为填补LVAD患者NTM感染相关文献空白，我们进行了系统综述并呈现所有先前报道的病例。
