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Ann Thorac Surg 2001;72:725-730
© 2001 The Society of Thoracic Surgeons
a Department of Infectious Disease, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
b Department of Cardiothoracic Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
c Transplant Center, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
d Department of Infection Control and Epidemiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Accepted for publication May 16, 2001.
Address reprint requests to Dr McCarthy, Department of Cardiothoracic Surgery, Kaufman Center For Heart Failure, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195
e-mail: mccartp{at}ccf.org
Background. Implantable left ventricular assist devices (LVAD) are used as a bridge to transplantation but are associated with a high risk of infection including nosocomial bloodstream infections (BSI).
Methods. We retrospectively reviewed the medical records of all patients with implantable LVAD at the Cleveland Clinic with 72 hours or longer of LVAD support from January 1992 through June 2000, to determine the attack rate, incidence, and impact of nosocomial BSI in patients with LVAD. A nosocomial BSI was defined using Centers for Disease Control and Prevention definition. An LVAD-related BSI was defined as one where the same pathogen is cultured from the device and the blood with no other obvious source. Two hundred fourteen patients were included in the study (17,831 LVAD-days).
Results. One hundred forty BSI were identified in 104 patients for an attack rate of 49% and incidence of 7.9 BSI per 1000 LVAD-days. Thirty-eight percent of the BSI were LVAD associated. The most common pathogens causing BSI were coagulase-negative staphylococci (n = 33), Staphylococcus aureus, and Candida spp. (19 each), and Pseudomonas aeruginosa (16 each). A Cox proportional hazard model found BSI in patients with LVAD to be significantly associated with death (hazard ratio = 4.02, p < 0.001). Fungemia had the highest hazard ratio (10.9), followed by gram-negative bacteremia (5.1), and gram-positive bacteremia (2.2).
Conclusions. Patients with implantable LVAD have a high incidence of BSI, which are associated with a significantly increased mortality. Strategies for prevention of infection in LVAD recipients should focus on the drive line exit site until technical advances can achieve a totally implantable device.
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