Division of Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC.
Section of Infectious Diseases, Department of Medicine, MedStar Washington Hospital Center, Washington, DC.
Tex Heart Inst J. 2022 Jul 1;49(4). doi: 10.14503/THIJ-20-7498.
Durable left ventricular assist devices (LVADs) provide circulatory support in patients with end-stage heart failure; however, complications include infection of the driveline exit site. Nontuberculous mycobacterial infections are rare in patients with LVADs, but they should be considered in those who have undergone device exchanges and have bacterial infections with driveline exit-site discharge but no fever or leukocytosis. We reviewed the charts of patients who had an LVAD implanted at our institution from January 2009 through December 2019, to identify those with a device-related nontuberculous mycobacterial infection. Collected data included patient demographics, premorbid conditions, infection type, previous device complications, treatment, and outcomes. We identified infections in 3 patients (mean age, 41 yr): Mycobacterium abscessus in 2 and M. chimaera in 1. All had a HeartMate II device and had undergone device exchanges for pump thrombosis or for driveline fault or infections. All presented with driveline exit-site discharge without fever or leukocytosis. The mean time between initial device implantation and diagnosis of a nontuberculous mycobacterial infection was 55 months. All 3 patients were treated with antibiotics and underwent localized surgical débridement; one underwent an additional device exchange. The M. abscessus infections disseminated, and both patients died; the patient with M. chimaera infection continued to take suppressive antibiotics. Nontuberculous mycobacterial infections are associated with high morbidity and mortality rates, warranting prompt diagnosis and treatment.
耐用型左心室辅助装置（LVAD）为终末期心力衰竭患者提供循环支持；然而，并发症包括驱动轴出口部位感染。LVAD 患者中非结核分枝杆菌感染罕见，但对于那些经历过器械更换且存在带有驱动轴出口部位排出物的细菌感染而无发热或白细胞增多的患者，应考虑到这种感染。我们回顾了 2009 年 1 月至 2019 年 12 月在我们机构植入 LVAD 的患者的病历，以确定与器械相关的非结核分枝杆菌感染患者。收集的数据包括患者人口统计学、发病前状况、感染类型、先前的器械并发症、治疗和结果。我们确定了 3 名患者（平均年龄 41 岁）存在感染：2 名患者为脓肿分枝杆菌感染，1 名患者为土拉热弗朗西丝菌感染。所有患者均植入 HeartMate II 装置，因泵血栓形成或驱动轴故障或感染而进行了器械更换。所有患者均表现为驱动轴出口部位排出物而无发热或白细胞增多。初次植入器械与诊断非结核分枝杆菌感染之间的平均时间为 55 个月。所有 3 名患者均接受了抗生素治疗和局部手术清创；1 名患者进行了额外的器械更换。脓肿分枝杆菌感染扩散，两名患者死亡；感染土拉热弗朗西丝菌的患者继续服用抑制性抗生素。非结核分枝杆菌感染与高发病率和死亡率相关，需要及时诊断和治疗。
