Details

Autor(en) / Beteiligte

• Trachtenberg, Barry H., MD
• Cordero-Reyes, Andrea M., MD
• Aldeiri, Molham, MD
• Alvarez, Paulino, MD
• Bhimaraj, Arvind, MD
• Ashrith, Guha, MD
• Elias, Barbara, RN
• Suarez, Erik E., MD
• Bruckner, Brian, MD
• Loebe, Matthias, MD
• Harris, Richard L., MD
• Zhang, J. Yi, MD
• Torre-Amione, Guillermo, MD, PhD
• Estep, Jerry D., MD

Titel

Persistent Blood Stream Infection in Patients Supported With a Continuous-Flow Left Ventricular Assist Device Is Associated With an Increased Risk of Cerebrovascular Accidents

Ist Teil von

• Journal of cardiac failure, 2015-02, Vol.21 (2), p.119-125

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2015

Quelle

Access via ScienceDirect (Elsevier)

Beschreibungen/Notizen

• Abstract Background Common adverse events in patients supported with Continuous-flow left ventricular assist devices (CF-LVAD) include infections and cerebrovascular accidents (CVA). Some studies have suggested a possible association between blood stream infection (BSI) and CVA. Methods and Results Medical records of patients who received Heartmate II (HMII) CF-LVADs in 2008–2012 at a single center were reviewed. CVA was categorized as either hemorrhagic (HCVA) or ischemic (ICVA). BSI was divided into persistent (pBSI) and nonpersistent (non-pBSI). pBSI was defined as BSI with the same organism on repeated blood culture >72 hours from initial blood culture despite antibiotics. Univariate and multivariate analyses were performed to determine predictors. A total of 149 patients had HMII implanted; 76% were male, and the overall mean age was 55.4 ± 13 years. There were a total of 19 (13%) patients who had CVA (7 HCVA and 12 ICVA) at a median of 295 days (range 5–1,096 days) after implantation. There were a total of 28 (19%) patients with pBSI and 17 (11%) patients with non-pBSI. Patients with pBSI had a trend toward greater BMI (31 kg/m2 vs 27 kg/m2 ; P  = .09), and longer duration of support (1,019 d vs 371 d; P < .001) compared with those with non-pBSI. Persistent BSI was associated with an increased risk of mortality and with all-cause CVA on multivariate analysis (odds ratio [OR] 5.97; P  = .003) as well as persistent Pseudomonas aeruginosa infection (OR 4.54; P  = .048). Conclusions Persistent BSI is not uncommon in patients supported by CF-LVAD and is highly associated with all-cause CVA and increased all-cause mortality.