Eichenberger Emily M, Satola Sarah, Gupta Divya, Daneshmand Mani, Pouch Stephanie
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
J Heart Lung Transplant. 2023 Nov;42(11):1501-1504. doi: 10.1016/j.healun.2023.07.011. Epub 2023 Jul 27.
The outcomes and management of bloodstream infection (BSI) in patients on temporary mechanical circulatory support (TMCS) awaiting heart transplant (HT) are poorly understood. We present outcomes of patients on TMCS with BSI (TMCS-I) relative to matched uninfected patients (TMCS-U) and discuss their management. Between January 1, 2013, and April 30, 2023, N = 136 patients were bridged to transplant with TMCS at Emory Transplant Center. Twenty-one (15.4%) patients were TMCS-I. Two (9.5%) had infective endocarditis. Median duration of antimicrobial treatment was 24 days (interquartile range 28.3). All TMCS-I were reactivated for transplant within 48 to 72 hours of negative blood cultures. None developed recurrent BSI. Post-transplant survival did not differ between TMCS-I and TMCS-U (p = 0.38). HT for TMCS-I may be safe as soon as blood cultures clear. Duration of antimicrobial therapy is individualized and depends on the organism, duration of bacteremia, presence of endocarditis, and timing of HT. Additional research is needed to determine optimal duration of treatment.
对于等待心脏移植（HT）的接受临时机械循环支持（TMCS）的患者，血流感染（BSI）的结局和管理尚不清楚。我们报告了发生BSI的TMCS患者（TMCS-I）相对于匹配的未感染患者（TMCS-U）的结局，并讨论了他们的管理情况。在2013年1月1日至2023年4月30日期间，埃默里移植中心有N = 136例患者通过TMCS过渡到移植。21例（15.4%）患者为TMCS-I。2例（9.5%）患有感染性心内膜炎。抗菌治疗的中位持续时间为24天（四分位间距为28.3）。所有TMCS-I在血培养阴性后的48至72小时内重新启动移植。均未发生复发性BSI。TMCS-I和TMCS-U之间的移植后生存率无差异（p = 0.38）。一旦血培养转阴，TMCS-I进行HT可能是安全的。抗菌治疗的持续时间是个体化的，取决于病原体、菌血症持续时间、心内膜炎的存在以及HT的时机。需要进一步研究以确定最佳治疗持续时间。
