1108. Fever in Ventricular Assist Device Patients
Session: Poster Abstract Session: Infections of Cardiovascular Devices
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Infection is a serious complication of pediatric ventricular assist devices (VAD).  While fever can be a sign of infection requiring broad spectrum empiric antibiotics, inflammation is also common in VAD recipients. We sought to assess how often fevers in pediatric VAD recipients are associated with documented infections and how well inflammatory markers detect infections. 

Methods: Data were collected on all recipients of VADs at Children’s Hospital of Pittsburgh from 2002 – 2010 using the hospital EMR.  Patients without complete electronic data were not included in the study.  Data collected included demographics (age, gender, diagnosis, reason for VAD placement, number of VAD days), vital signs and laboratory data (number of febrile days with VAD, ESR, CRP and WBC values while VAD was present), microbiologic culture data (including site, type of culture, and final outgrowth), antibiotic exposure, and outcomes of VAD placement.  Number of febrile days in the 14 days following VAD explanation was also measured to assess the effect of VAD removal on the frequency of fever.  Fever was defined as any temperature ≥ 38.0°C.

Results: We identified 20 pediatric VAD recipients. Median age was 6.9 years (range 0 – 18 years).  Total VAD duration was 507 days (mean 25.4 ± 6.9).   The total number of febrile VAD days was 154 (mean 7.7 ± 6.2, 30% of total VAD days).  The total number of febrile days after VAD explantation was 46 (mean 2.3 ± 3.1, 16% of post-explanation days, p=0.03 compared to VAD days).  Blood cultures were obtained on 198 individual VAD days (39%).  Only 2 episodes of bacteremia were identified (one Enterococcus, one Pseudomonas).  WBC count was  abnormal (≥15,000) on 52% of VAD days, including 43% of days without fever. CRP was abnormal on 148/162 (91%) of assays, with the majority of abnormal tests (83/148) occurring while patients were afebrile.   VAD patients received at least one antibiotic on 83% of VAD days, with vancomycin used on 51% of those days.

Conclusion: Fever and elevated inflammatory markers in the absence of infection are common among pediatric VAD patients. Their persistence may not warrant broad spectrum antibiotic exposure and should not exclude patients from organ transplantation.


Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Lindsay Tawa, BA, University of Pittsburgh School of Medicine, Pittsburgh, PA, Peter Wearden, MD, PhD, Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, Brian Feingold, MD, MS, Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA and Andrew Nowalk, MD, PhD, Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA

Disclosures:

L. Tawa, None

P. Wearden, None

B. Feingold, None

A. Nowalk, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.