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Ann Thorac Surg 2001;72:96-101
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

Relapsing bacteremia in patients with ventricular assist device: an emergent complication of extended circulatory support

Regis A. Vilchez, MDa, M. Catherine McEllistrem, MDc, Lee H. Harrison, MDc, Kenneth R. McCurry, MDb, Robert L. Kormos, MDb, Shimon Kusne, MDa,b a Department of Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
b Department of Surgery, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
c Infectious Diseases Epidemiology Research Unit, School of Medicine and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

Accepted for publication April 3, 2001.

Address reprint requests to Dr Kusne, Division of Infectious Diseases, University of Pittsburgh Medical Center, 501 Kauffman Bldg, 3471 Fifth Ave, Pittsburgh, PA 15213
e-mail: kusnes2{at}msx.upmc.edu

Background. Ventricular assist devices (VAD) are currently approved for use as a bridge for transplantation. Although reports have suggested acceptable rates of survival of patients with VAD, there is little information regarding the mechanism and etiology of bacteremia in these patients.

Methods. We prospectively followed patients who underwent VAD implantation and developed bacteremia during VAD support at the University of Pittsburgh Medical Center. Relapsing bacteremia was defined as at least two episodes of positive blood cultures with a genetically related organism on 2 different days. Species identification and susceptibility testing were performed on all isolates. Pulse field gel electrophoresis was performed on selected blood and VAD isolates.

Results. Between January 1998 and August 1999, 3 patients with VAD developed relapsing bacteremia, which was treated with full courses of antibiotic agents, 2 of whom also developed VAD endocarditis. All 3 patients had documented driveline or device pocket infections with these isolates. Consecutive blood and VAD isolates were found to be genetically related within each patient.

Conclusions. These patients with bacteremia after VAD implantation had relapse due to the same strain, which may have originated from indolent driveline infection. Endovascular infection in this setting is difficult to eradicate with antibiotic agents and carries a high mortality. These patients should be considered to have priority for orthotopic heart transplantation.




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