Bloodstream infections in mechanical circulatory support device recipients in the International Society of Heart and Lung Transplantation Mechanically Assisted Circulation Support Registry

Epidemiology, risk factors, and mortality

Saima Aslam, Rongbing Xie, Jennifer Cowger, James K. Kirklin, Vivian H. Chu, Stephan Schueler, Theo de By, Kate Gould, Orla Morrissey, Lars H. Lund, Stanley Martin, Daniel J. Goldstein, Margaret Hannan

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: We used multicenter international data from the International Society of Heart and Lung Transplantation Mechanically Assisted Circulation Support (IMACS) registry to determine bloodstream infection (BSI) event rate, independent risk factors, and association with mortality. Methods: Included were patients registered in IMACS from January 2013 through December 2015, assessed BSI event rate of mechanical circulatory support (MCS) and non–MCS-related BSIs, and conducted univariate and multivariate analyses between BSI with baseline characteristics and mortality. Results: We documented 1,606 BSIs in 1,231 of 10,171 MCS recipients (12%), with an event rate of 2.43 BSIs/100 patient-months within 3 months after implant (early onset) and 1.03 BSIs/100 patient-months after 3 months (late onset). Of these episodes, 1,378 (85.8%) were non– MCS-related BSI. Increasing body mass index and bilirubin were independent correlates of MCS-related BSI. Independent correlates of non–MCS-related BSI included older age, higher body mass index, previous cardiac surgery, baseline chronic renal disease and dialysis, pre-implant frailty, presence of biventricular assist device, total artificial heart or right ventricular assist device, and Interagency Registry for Mechanically Assisted Circulatory Support category 1. Survival after 3 months after implant of patients who developed early-onset BSI was 56.9% at 24 months vs 77.4% in patients without early-onset BSI (p < 0.001). Early-onset BSI was an independent correlate of mortality at 3 months after implantation (hazard ratio, 2.56; 95% confidence interval, 2.09-3.15; p < 0.001). Conclusions: Early-onset BSI was associated with significantly increased 24-month mortality. More than 85% of these BSIs were not device related. There is an opportunity for infection prevention practices to decrease the BSI event rate, which may affect 24-month survival. These data can also serve as benchmarking for individual institutions.

Original languageEnglish (US)
JournalJournal of Heart and Lung Transplantation
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Assisted Circulation
Heart-Lung Transplantation
Registries
Epidemiology
Equipment and Supplies
Mortality
Infection
Body Mass Index
Artificial Heart
Benchmarking
Heart-Assist Devices
Survival
Chronic Renal Insufficiency
Bilirubin

Keywords

  • bloodstream infections
  • IMACS registry
  • mechanical circulatory support device
  • VAD infection
  • ventricular assist device

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

Bloodstream infections in mechanical circulatory support device recipients in the International Society of Heart and Lung Transplantation Mechanically Assisted Circulation Support Registry : Epidemiology, risk factors, and mortality. / Aslam, Saima; Xie, Rongbing; Cowger, Jennifer; Kirklin, James K.; Chu, Vivian H.; Schueler, Stephan; de By, Theo; Gould, Kate; Morrissey, Orla; Lund, Lars H.; Martin, Stanley; Goldstein, Daniel J.; Hannan, Margaret.

In: Journal of Heart and Lung Transplantation, 01.01.2018.

Research output: Contribution to journalArticle

Aslam, Saima ; Xie, Rongbing ; Cowger, Jennifer ; Kirklin, James K. ; Chu, Vivian H. ; Schueler, Stephan ; de By, Theo ; Gould, Kate ; Morrissey, Orla ; Lund, Lars H. ; Martin, Stanley ; Goldstein, Daniel J. ; Hannan, Margaret. / Bloodstream infections in mechanical circulatory support device recipients in the International Society of Heart and Lung Transplantation Mechanically Assisted Circulation Support Registry : Epidemiology, risk factors, and mortality. In: Journal of Heart and Lung Transplantation. 2018.
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title = "Bloodstream infections in mechanical circulatory support device recipients in the International Society of Heart and Lung Transplantation Mechanically Assisted Circulation Support Registry: Epidemiology, risk factors, and mortality",
abstract = "Background: We used multicenter international data from the International Society of Heart and Lung Transplantation Mechanically Assisted Circulation Support (IMACS) registry to determine bloodstream infection (BSI) event rate, independent risk factors, and association with mortality. Methods: Included were patients registered in IMACS from January 2013 through December 2015, assessed BSI event rate of mechanical circulatory support (MCS) and non–MCS-related BSIs, and conducted univariate and multivariate analyses between BSI with baseline characteristics and mortality. Results: We documented 1,606 BSIs in 1,231 of 10,171 MCS recipients (12{\%}), with an event rate of 2.43 BSIs/100 patient-months within 3 months after implant (early onset) and 1.03 BSIs/100 patient-months after 3 months (late onset). Of these episodes, 1,378 (85.8{\%}) were non– MCS-related BSI. Increasing body mass index and bilirubin were independent correlates of MCS-related BSI. Independent correlates of non–MCS-related BSI included older age, higher body mass index, previous cardiac surgery, baseline chronic renal disease and dialysis, pre-implant frailty, presence of biventricular assist device, total artificial heart or right ventricular assist device, and Interagency Registry for Mechanically Assisted Circulatory Support category 1. Survival after 3 months after implant of patients who developed early-onset BSI was 56.9{\%} at 24 months vs 77.4{\%} in patients without early-onset BSI (p < 0.001). Early-onset BSI was an independent correlate of mortality at 3 months after implantation (hazard ratio, 2.56; 95{\%} confidence interval, 2.09-3.15; p < 0.001). Conclusions: Early-onset BSI was associated with significantly increased 24-month mortality. More than 85{\%} of these BSIs were not device related. There is an opportunity for infection prevention practices to decrease the BSI event rate, which may affect 24-month survival. These data can also serve as benchmarking for individual institutions.",
keywords = "bloodstream infections, IMACS registry, mechanical circulatory support device, VAD infection, ventricular assist device",
author = "Saima Aslam and Rongbing Xie and Jennifer Cowger and Kirklin, {James K.} and Chu, {Vivian H.} and Stephan Schueler and {de By}, Theo and Kate Gould and Orla Morrissey and Lund, {Lars H.} and Stanley Martin and Goldstein, {Daniel J.} and Margaret Hannan",
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language = "English (US)",
journal = "Journal of Heart and Lung Transplantation",
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T1 - Bloodstream infections in mechanical circulatory support device recipients in the International Society of Heart and Lung Transplantation Mechanically Assisted Circulation Support Registry

T2 - Epidemiology, risk factors, and mortality

AU - Aslam, Saima

AU - Xie, Rongbing

AU - Cowger, Jennifer

AU - Kirklin, James K.

AU - Chu, Vivian H.

AU - Schueler, Stephan

AU - de By, Theo

AU - Gould, Kate

AU - Morrissey, Orla

AU - Lund, Lars H.

AU - Martin, Stanley

AU - Goldstein, Daniel J.

AU - Hannan, Margaret

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: We used multicenter international data from the International Society of Heart and Lung Transplantation Mechanically Assisted Circulation Support (IMACS) registry to determine bloodstream infection (BSI) event rate, independent risk factors, and association with mortality. Methods: Included were patients registered in IMACS from January 2013 through December 2015, assessed BSI event rate of mechanical circulatory support (MCS) and non–MCS-related BSIs, and conducted univariate and multivariate analyses between BSI with baseline characteristics and mortality. Results: We documented 1,606 BSIs in 1,231 of 10,171 MCS recipients (12%), with an event rate of 2.43 BSIs/100 patient-months within 3 months after implant (early onset) and 1.03 BSIs/100 patient-months after 3 months (late onset). Of these episodes, 1,378 (85.8%) were non– MCS-related BSI. Increasing body mass index and bilirubin were independent correlates of MCS-related BSI. Independent correlates of non–MCS-related BSI included older age, higher body mass index, previous cardiac surgery, baseline chronic renal disease and dialysis, pre-implant frailty, presence of biventricular assist device, total artificial heart or right ventricular assist device, and Interagency Registry for Mechanically Assisted Circulatory Support category 1. Survival after 3 months after implant of patients who developed early-onset BSI was 56.9% at 24 months vs 77.4% in patients without early-onset BSI (p < 0.001). Early-onset BSI was an independent correlate of mortality at 3 months after implantation (hazard ratio, 2.56; 95% confidence interval, 2.09-3.15; p < 0.001). Conclusions: Early-onset BSI was associated with significantly increased 24-month mortality. More than 85% of these BSIs were not device related. There is an opportunity for infection prevention practices to decrease the BSI event rate, which may affect 24-month survival. These data can also serve as benchmarking for individual institutions.

AB - Background: We used multicenter international data from the International Society of Heart and Lung Transplantation Mechanically Assisted Circulation Support (IMACS) registry to determine bloodstream infection (BSI) event rate, independent risk factors, and association with mortality. Methods: Included were patients registered in IMACS from January 2013 through December 2015, assessed BSI event rate of mechanical circulatory support (MCS) and non–MCS-related BSIs, and conducted univariate and multivariate analyses between BSI with baseline characteristics and mortality. Results: We documented 1,606 BSIs in 1,231 of 10,171 MCS recipients (12%), with an event rate of 2.43 BSIs/100 patient-months within 3 months after implant (early onset) and 1.03 BSIs/100 patient-months after 3 months (late onset). Of these episodes, 1,378 (85.8%) were non– MCS-related BSI. Increasing body mass index and bilirubin were independent correlates of MCS-related BSI. Independent correlates of non–MCS-related BSI included older age, higher body mass index, previous cardiac surgery, baseline chronic renal disease and dialysis, pre-implant frailty, presence of biventricular assist device, total artificial heart or right ventricular assist device, and Interagency Registry for Mechanically Assisted Circulatory Support category 1. Survival after 3 months after implant of patients who developed early-onset BSI was 56.9% at 24 months vs 77.4% in patients without early-onset BSI (p < 0.001). Early-onset BSI was an independent correlate of mortality at 3 months after implantation (hazard ratio, 2.56; 95% confidence interval, 2.09-3.15; p < 0.001). Conclusions: Early-onset BSI was associated with significantly increased 24-month mortality. More than 85% of these BSIs were not device related. There is an opportunity for infection prevention practices to decrease the BSI event rate, which may affect 24-month survival. These data can also serve as benchmarking for individual institutions.

KW - bloodstream infections

KW - IMACS registry

KW - mechanical circulatory support device

KW - VAD infection

KW - ventricular assist device

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