Prospective, multicenter study of ventricular assist device infections

Rachel J. Gordon, Alan D. Weinberg, Francis D. Pagani, Mark S. Slaughter, Pat S. Pappas, Yoshifumi Naka, Daniel J. Goldstein, Walter P. Dembitsky, Julie C. Giacalone, Jennifer Ferrante, Deborah D. Ascheim, Alan J. Moskowitz, Eric A. Rose, Annetine C. Gelijns, Franklin D. Lowy

Research output: Contribution to journalArticle

111 Citations (Scopus)

Abstract

Background-Ventricular assist devices (VADs) improve survival and quality of life in patients with advanced heart failure, but their use is frequently complicated by infection. There are limited data on the microbiology and epidemiology of these infections. Methods and Results-One hundred fifty patients scheduled for VAD implantation were enrolled (2006-2008) at 11 US cardiac centers and followed prospectively until transplantation, explantation for recovery, death, or for 1 year. Eightysix patients (57%) received HeartMate II devices. Data were collected on potential preoperative, intraoperative, and postoperative risk factors for infection. Clinical, laboratory, and microbiological data were collected for suspected infections and evaluated by an infectious diseases specialist. Thirty-three patients (22%) developed 34 VAD-related infections with an incidence rate of 0.10 per 100 person-days (95% confidence interval, 0.073-0.142). The median time to infection was 68 days. The driveline was the most commonly infected site (n=28); 18 (64%) were associated with invasive disease. Staphylococci were the most common pathogen (47%), but pseudomonas or other Gram-negative bacteria caused 32% of infections. A history of depression and elevated baseline serum creatinine were independent predictors of VAD infection (adjusted hazard ratio=2.8 [P=0.007] and 1.7 [P=0.023], respectively). The HeartMate II was not associated with a decreased risk of infection. VAD infection increased 1-year mortality (adjusted hazard ratio=5.6; P<0.0001). Conclusions-This prospective, multicenter study demonstrates that infection frequently complicates VAD placement and is a continuing problem despite the use of newer, smaller devices. Depression and renal dysfunction may increase the risk of VAD infection. VAD infection is a serious consequence because it adversely affects patient survival. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01471795. (Circulation. 2013;127:691-702.).

Original languageEnglish (US)
Pages (from-to)691-702
Number of pages12
JournalCirculation
Volume127
Issue number6
DOIs
StatePublished - Feb 12 2013

Fingerprint

Heart-Assist Devices
Multicenter Studies
Prospective Studies
Infection
Equipment and Supplies
Survival
Pseudomonas
Microbiology
Gram-Negative Bacteria
Staphylococcus
Communicable Diseases
Creatinine
Epidemiology

Keywords

  • Depression
  • Heart failure
  • Heart-assist devices
  • Infection
  • Kidney

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Gordon, R. J., Weinberg, A. D., Pagani, F. D., Slaughter, M. S., Pappas, P. S., Naka, Y., ... Lowy, F. D. (2013). Prospective, multicenter study of ventricular assist device infections. Circulation, 127(6), 691-702. https://doi.org/10.1161/CIRCULATIONAHA.112.128132

Prospective, multicenter study of ventricular assist device infections. / Gordon, Rachel J.; Weinberg, Alan D.; Pagani, Francis D.; Slaughter, Mark S.; Pappas, Pat S.; Naka, Yoshifumi; Goldstein, Daniel J.; Dembitsky, Walter P.; Giacalone, Julie C.; Ferrante, Jennifer; Ascheim, Deborah D.; Moskowitz, Alan J.; Rose, Eric A.; Gelijns, Annetine C.; Lowy, Franklin D.

In: Circulation, Vol. 127, No. 6, 12.02.2013, p. 691-702.

Research output: Contribution to journalArticle

Gordon, RJ, Weinberg, AD, Pagani, FD, Slaughter, MS, Pappas, PS, Naka, Y, Goldstein, DJ, Dembitsky, WP, Giacalone, JC, Ferrante, J, Ascheim, DD, Moskowitz, AJ, Rose, EA, Gelijns, AC & Lowy, FD 2013, 'Prospective, multicenter study of ventricular assist device infections', Circulation, vol. 127, no. 6, pp. 691-702. https://doi.org/10.1161/CIRCULATIONAHA.112.128132
Gordon RJ, Weinberg AD, Pagani FD, Slaughter MS, Pappas PS, Naka Y et al. Prospective, multicenter study of ventricular assist device infections. Circulation. 2013 Feb 12;127(6):691-702. https://doi.org/10.1161/CIRCULATIONAHA.112.128132
Gordon, Rachel J. ; Weinberg, Alan D. ; Pagani, Francis D. ; Slaughter, Mark S. ; Pappas, Pat S. ; Naka, Yoshifumi ; Goldstein, Daniel J. ; Dembitsky, Walter P. ; Giacalone, Julie C. ; Ferrante, Jennifer ; Ascheim, Deborah D. ; Moskowitz, Alan J. ; Rose, Eric A. ; Gelijns, Annetine C. ; Lowy, Franklin D. / Prospective, multicenter study of ventricular assist device infections. In: Circulation. 2013 ; Vol. 127, No. 6. pp. 691-702.
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abstract = "Background-Ventricular assist devices (VADs) improve survival and quality of life in patients with advanced heart failure, but their use is frequently complicated by infection. There are limited data on the microbiology and epidemiology of these infections. Methods and Results-One hundred fifty patients scheduled for VAD implantation were enrolled (2006-2008) at 11 US cardiac centers and followed prospectively until transplantation, explantation for recovery, death, or for 1 year. Eightysix patients (57{\%}) received HeartMate II devices. Data were collected on potential preoperative, intraoperative, and postoperative risk factors for infection. Clinical, laboratory, and microbiological data were collected for suspected infections and evaluated by an infectious diseases specialist. Thirty-three patients (22{\%}) developed 34 VAD-related infections with an incidence rate of 0.10 per 100 person-days (95{\%} confidence interval, 0.073-0.142). The median time to infection was 68 days. The driveline was the most commonly infected site (n=28); 18 (64{\%}) were associated with invasive disease. Staphylococci were the most common pathogen (47{\%}), but pseudomonas or other Gram-negative bacteria caused 32{\%} of infections. A history of depression and elevated baseline serum creatinine were independent predictors of VAD infection (adjusted hazard ratio=2.8 [P=0.007] and 1.7 [P=0.023], respectively). The HeartMate II was not associated with a decreased risk of infection. VAD infection increased 1-year mortality (adjusted hazard ratio=5.6; P<0.0001). Conclusions-This prospective, multicenter study demonstrates that infection frequently complicates VAD placement and is a continuing problem despite the use of newer, smaller devices. Depression and renal dysfunction may increase the risk of VAD infection. VAD infection is a serious consequence because it adversely affects patient survival. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01471795. (Circulation. 2013;127:691-702.).",
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AU - Naka, Yoshifumi

AU - Goldstein, Daniel J.

AU - Dembitsky, Walter P.

AU - Giacalone, Julie C.

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N2 - Background-Ventricular assist devices (VADs) improve survival and quality of life in patients with advanced heart failure, but their use is frequently complicated by infection. There are limited data on the microbiology and epidemiology of these infections. Methods and Results-One hundred fifty patients scheduled for VAD implantation were enrolled (2006-2008) at 11 US cardiac centers and followed prospectively until transplantation, explantation for recovery, death, or for 1 year. Eightysix patients (57%) received HeartMate II devices. Data were collected on potential preoperative, intraoperative, and postoperative risk factors for infection. Clinical, laboratory, and microbiological data were collected for suspected infections and evaluated by an infectious diseases specialist. Thirty-three patients (22%) developed 34 VAD-related infections with an incidence rate of 0.10 per 100 person-days (95% confidence interval, 0.073-0.142). The median time to infection was 68 days. The driveline was the most commonly infected site (n=28); 18 (64%) were associated with invasive disease. Staphylococci were the most common pathogen (47%), but pseudomonas or other Gram-negative bacteria caused 32% of infections. A history of depression and elevated baseline serum creatinine were independent predictors of VAD infection (adjusted hazard ratio=2.8 [P=0.007] and 1.7 [P=0.023], respectively). The HeartMate II was not associated with a decreased risk of infection. VAD infection increased 1-year mortality (adjusted hazard ratio=5.6; P<0.0001). Conclusions-This prospective, multicenter study demonstrates that infection frequently complicates VAD placement and is a continuing problem despite the use of newer, smaller devices. Depression and renal dysfunction may increase the risk of VAD infection. VAD infection is a serious consequence because it adversely affects patient survival. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01471795. (Circulation. 2013;127:691-702.).

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KW - Depression

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