Abstract
Background
Infections remain a frequent complication of patients (patients) with ventricular assist devices (VAD). We evaluated the epidemiology and outcomes of VAD infections at our center over a 10-year period.
Methods
We performed a retrospective cohort study of continuous-flow VAD recipients from July 2008-September 2018. VAD-specific and -related infections were characterized according to 2013 ISHLT definitions. Summary and comparative statistics were performed using IBM® SPSS Statistics version 25.0.
Results
433 VADs were implanted into 375 patients. A total of 86 VAD infections occurred in 79 patients, with a mean incidence of 0.19 episodes/VAD and 0.20 episodes/pt. Patients with infections were predominantly male (73.3%) and Caucasian (54.6%), and had mean age of 52.7 years, nonischemic cardiomyopathy (58.1%), and VAD as bridge to transplant (53.5%, n = 46). Types of VAD included 43.0% axial (n = 37) and 57.0% centrifugal flow (n = 49). 78% of patients with infections were colonized with at least one multidrug-resistant organism (MDRO) such as MRSA (29%), VRE (73%), and ESBL (24%).
Notably, 15% of infections (n = 13) occurred within 60 d of VAD implantation, with mean time to onset 36 d (5–60 d) post-VAD. Early infections (<60d) involved driveline exit site (DLES) (n = 4), pocket (n = 3), and pump (n = 7) with 7 VAD-related blood stream infections (BSI), 6 infective endocarditis (IE), and 2 mediastinitis. Early infections involved Gram-positive (GP) bacteria (84.6%, n = 11), Gram-negatives (GN) (45.5%, n = 5), anaerobes (23.1%, n = 3), fungi (30.8%, n = 4), MDRO (61.5%, n = 8) and 32 pathogens (69.2%, n = 9). 85% of infections occurred late (n = 73) with mean time to onset 338 d (69–1215 d). In late infections (>60d), impacted sites included DLES (n = 38), pocket (n = 7), and pump (n = 40), with 42 BSI, 36 IE, and 2 mediastinitis. Pathogens were 68.5% GP (n = 50), 37.0% GN (n = 27), 2.7% anaerobes (n = 2), 2.7% fungi (n = 2), 17.8% MDRO (n = 13), and 26.0% polymicrobial (n = 19).
Conclusion
In this longitudinal retrospective cohort of patients supported with VADs, a majority of infections occurred >9 months post-implantation. GP pathogens predominated at all time-points. GN bacteria, including MDROs, anaerobes, and fungi are increasingly encountered. The vast majority of patients were colonized with ³1 MDRO during the course of VAD implantation.
Disclosures
All authors: No reported disclosures.
1177. A Spectrum of Infectious Complications in Continuous-Flow Ventricular Assist Devices: A Single-Center Longitudinal Cohort
