Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Mich.
Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Mich.
J Thorac Cardiovasc Surg. 2023 Aug;166(2):570-579.e4. doi: 10.1016/j.jtcvs.2021.10.056. Epub 2021 Nov 9.
Although infections are common after left ventricular assist device implantation, the relationship between timing and type of first infection with regard to mortality is less well understood.
The Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support patients receiving a primary left ventricular assist device from April 2012 to May 2017 were included. The primary exposure was defined 3 ways: any infection, timing of first infection (early: ≤90 days; intermediate: 91-180 days; late: >180 days), and type (ventricular assist device specific, ventricular assist device related, non-ventricular assist device). The association between first infection and all-cause mortality was estimated using Cox regression.
The cohort included 12,957 patients at 166 centers (destination therapy: 47.4%, bridge-to-transplant: 41.2%). First infections were most often non-ventricular assist device (54.2%). Rates of first infection were highest in the early interval (10.7/100 person-months). Patients with any infection had a significantly higher adjusted hazard of death (hazard ratio, 2.63; 2.46-2.86). First infection in the intermediate interval was associated with the largest increase in adjusted hazard of death (hazard ratio, 3.26; 2.82-3.78), followed by late (hazard ratio, 3.13; 2.77-3.53) and early intervals (hazard ratio, 2.37; 2.16-2.60). Ventricular assist device-related infections were associated with the largest increase in hazard of death (hazard ratio, 3.02; 2.69-3.40), followed by ventricular assist device specific (hazard ratio, 2.92; 2.57-3.32) and non-ventricular assist device (hazard ratio, 2.42; 2.20-2.65).
Relative to those without infection, patients with any postimplantation infection had an increased risk of death. Ventricular assist device-related infections and infections occurring in the intermediate interval were associated with the largest increase in risk of death. After left ventricular assist device implantation, infection prevention strategies should target non-ventricular assist device infections in the first 90 days, then shift to surveillance/prevention of driveline infections after 90 days.
尽管左心室辅助装置植入后感染很常见，但首次感染的时间和类型与死亡率之间的关系尚不清楚。
纳入 2012 年 4 月至 2017 年 5 月期间接受原发性左心室辅助装置治疗的胸外科医师协会机械循环支持机构注册登记患者。主要暴露因素定义为以下 3 种情况：任何感染、首次感染的时间（早期：≤90 天；中期：91-180 天；晚期：>180 天）和类型（心室辅助装置特异性、心室辅助装置相关、非心室辅助装置）。使用 Cox 回归估计首次感染与全因死亡率之间的关联。
该队列包括 166 个中心的 12957 例患者（终末期心衰治疗：47.4%，桥接移植：41.2%）。首次感染最常见的是非心室辅助装置（54.2%）。早期感染发生率最高（10.7/100 人-月）。任何感染的患者死亡风险明显增加（危险比，2.63；2.46-2.86）。中期感染与死亡风险增加的相关性最大（危险比，3.26；2.82-3.78），其次是晚期（危险比，3.13；2.77-3.53）和早期（危险比，2.37；2.16-2.60）。与心室辅助装置相关的感染与死亡风险增加相关性最大（危险比，3.02；2.69-3.40），其次是心室辅助装置特异性感染（危险比，2.92；2.57-3.32）和非心室辅助装置感染（危险比，2.42；2.20-2.65）。
与未感染的患者相比，任何植入后感染的患者死亡风险增加。与心室辅助装置相关的感染和中期发生的感染与死亡风险增加相关性最大。左心室辅助装置植入后，感染预防策略应针对前 90 天的非心室辅助装置感染，然后转移到 90 天后的驱动轴感染监测/预防。
