1109. Predictors of Infectious Complications and Mortality among Recipients of Left Ventricular Assist Devices
Session: Poster Abstract Session: Infections of Cardiovascular Devices
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • 1109_DanaLevy(4).pdf (558.6 kB)
  • Background: Left ventricular assist devices (LVADs) have become a viable option for patients with end stage heart failure. Today, these devices are implanted either as potential bridges to cardiac transplantation (BTT) or for destination therapy.  Few studies have focused specifically on predictors of infectious complications among patients with LVADs.  Our objective was to determine factors associated with the development of various infections among LVAD recipients and to identify infectious and non-infectious predictors of mortality.

    Methods: We retrospectively reviewed paper and electronic medical records for 69 patients who received an LVAD from January 2007- November 2010 at our center.  Collected data included demographics, presence of diabetes, history of Clostridium difficile colitis (CD), mortality, and incidence and types of infections after LVAD implantation.  The dataset was analyzed using statistical software to determine predictors of infection and mortality.

    Results: Of the 69 LVAD recipients, 48% had diabetes and 49% were BTT.  Forty-eight percent required preceding placement of an extracorporeal device (ECD) and 55% had concomitant cardiac surgery at the time of the LVAD placement.  Thirty-three percent developed bacteremia, of which 6 were device-related.  Driveline infections developed in 15 patients.  After LVAD, 29% developed CD, 48% developed pneumonia, and 18% developed catheter-related infections (CRI).  An ECD prior to LVAD insertion was associated with bacteremia [adjusted odds ratio ORADJ =3.37 (CI 1.16-9.84), P=0.026] and the development of CD [ORadj= 7.50 (CI 2.1-26.1), P= 0.001].  CRIs occurred less frequently in those undergoing additional cardiac surgery [ORADJ= 0.018 (CI 0.001-0.30), P= 0.005], and more frequently in patients with prolonged bypass time [ORADJ = 4.31 (CI 1.04-17.9), p 0.045].  Pneumonia after LVAD placement was associated with increased mortality [ORADJ 5.82 (CI 1.6-21.2), p= 0.007].

    Conclusion: Our study suggests that an ECD prior to LVAD placement and prolonged bypass time are predictive of infectious complications.  Post operative pneumonia was associated with increased mortality.  A larger prospective study is needed to further characterize predictors of infection and mortality.  


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

    Dana Levy, MD, Grace Minamoto, MD, Jonathan Shuter, MD and Victoria Muggia, MD, Infectious Diseases, Montefiore Medical Center, Bronx, NY

    Disclosures:

    D. Levy, None

    G. Minamoto, None

    J. Shuter, None

    V. Muggia, 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.