Left ventricular assist device-associated infections: incidence and risk factors

Andréa Rahal; Yvon Ruch; Nicolas Meyer; Stéphanie Perrier; Tam Hoang Minh; Clément Schneider; Thierry Lavigne; Sandrine Marguerite; Gharib Ajob; Mircea Cristinar; Eric Epailly; Jean-Philippe Mazzucotelli; Michel Kindo

doi:10.21037/jtd.2020.03.26

Left ventricular assist device-associated infections: incidence and risk factors

J Thorac Dis. 2020 May;12(5):2654-2662. doi: 10.21037/jtd.2020.03.26.

Authors

Affiliations

¹ Equipe Opérationnelle D'Hygiène, CHU de Strasbourg, 1, Place de l'Hôpital, 67091, Strasbourg, France.
² Department of Infectious Diseases, University Hospital, Nouvel Hôpital Civil, Strasbourg, France.
³ ICube, UMR7357, Université de Strasbourg, Strasbourg, France.
⁴ Department of Cardiovascular Surgery, University Hospitals of Strasbourg, Strasbourg, France.
⁵ Department of Anesthesia and Intensive Care Unit, University Hospitals of Strasbourg, Strasbourg, France.

Abstract

Background: Left ventricular assist device (LVAD)-associated infections are major complications that can lead to critical outcomes. The aims of this study were to assess the incidence of and to determine the risk factors for LVAD-associated infections.

Methods: We included all consecutive patients undergoing LVAD implantation between January 1, 2010, and January 1, 2019, in a single institution. Infection-related data were retrospectively collected by review of patient's medical files. LVAD-associated infections were classified into three categories: percutaneous driveline infections, pocket infections and pump and/or cannula infections.

Results: We enrolled 72 patients. Twenty-one (29.2%) patients presented a total of 32 LVAD-associated infections. Eight (38.1%) patients had more than one infection. Five (62.5%) pocket infections and one (50.0%) pump and/or cannula infection were preceded by a driveline infection. The median delay between the operation and LVAD-associated infection was 6.5 (1.4-12.4) months. The probability of having a LVAD-associated infection at one year after receiving an implant was 26.6% (95% CI: 17.5-40.5%). Percutaneous driveline infections represented 68.7% of all LVAD-associated infections. Staphylococcus aureus and coagulase-negative staphylococci were the predominant bacteria in LVAD-associated infections (53.1% and 15.6%, respectively). Hospital length of stay (sdHR =1.22 per 10 days; P=0.001) and postoperative hemodialysis (sdHR =0.17; P=0.004) were statistically associated with infection. Colonization with multidrug-resistant bacteria was more frequent in patients with LVAD-associated infections than in others patients (42.9% vs. 15.7%; P=0.013).

Conclusions: LVAD-associated infections remain an important complication and are mostly represented by percutaneous driveline infections. Gram-positive cocci are the main pathogens isolated in microbiological samples. Patients with LVAD-associated infections are more frequently colonized with multidrug-resistant bacteria.

Keywords: Heart failure; artificial heart ventricle; care; infection; postoperative; postoperative wound.