240. Gram-negative Ventricular Assist Device Infections Experience in a Tertiary Care Hospital
Session: Poster Abstract Session: Diagnostics: Miscellaneous
Thursday, October 8, 2015
Room: Poster Hall
Background: Ventricular assist devices (VADs) have become a commonly used treatment modality. Infections (INF) are amongst the most frequently associated complications. Gram -negative (GN) organisms have been increasingly encountered. We sought to analyze correlates and outcome of VADs GN-INF.

Methods: A retrospective study in a tertiary care hospital, between 2005 and 2013. INF were classified as VAD specific (VAD-S) and VAD related (VAD-R). VADs were categorized as temporary (TEMP) or permanent (PERM); pulsatile (PUL) or continuous (CONT). Data was collected on demographics, co-morbidities, microbiology and outcomes. Fisher’s exact test and chi- square test were used for analysis.

Results: A total of 436 VADs were inserted, 77 (18%) had GN-INF. Thirty seven (48%) had either VAD-S or VAD-R INF, of these 13 were VAD-S, 10 VAD-R, 14 had both VAD-S & VAD-R. Mean age 57 years (20-75), males 23 (62%), 16 (43%) had DM. Intra- aortic balloon pump (IABP) in 20(54%), permanent pacemaker (PPM) in 25(67%). Mediastinal exploration (ME) in 19(51%). VAD was placed between 2005- 2009 in 24 (65%). PERM 27(75%), TEMP 9 (25%)  CONT in 27(75%), PUL in 9(25%). All PUL were placed before 2010. Orthotopic heart transplant (OHT) in 10 (27%).  

Thirteen (35%) had driveline infections (DRI), 8 (61%) were polymicrobial, 5 (38%) Pseudomonas aeruginosa (PA), 3 (23%) multi-drug resistant (MDR). Ten (27%) had GN bacteremia (BC), 4 (40%) Klebsiella pneumoniae, 3 (30%) PA 1 of which was MDR. 

Fourteen pts (38%) had both DRI and BC. Fifteen isolates from DRI were MDR and 9 from BC were MDR.

Overall, 18 (49%) expired, 2 had MDR- PA in both DRI and BC. All pts with OHT survived.

Age, gender, presence of PPM were not significantly associated with INF. Increased number of ME was associated with higher DRI (p=0.018) and higher temperature was associated with BC (p= 0.061). OHT was performed more frequently in pts without BC (p = 0.007). PUL had higher DRI (100 % vs. 67%. p= 0.01).

Conclusion : GN-VAD INF in our pts was associated with significant mortality. Pts with increased number of ME and PUL VADs which are no longer used had significantly higher GN-INF.

Ami Patel, MD1, Eliahu Bishburg, MD, FIDSA2, Sandhya Nagarakanti, MD2 and Melinda Brown, MD2, (1)Carle Physician Group, Urbana, IL, (2)Family Treatment Center, Newark Beth Israel Medical Center, Newark, NJ


A. Patel, None

E. Bishburg, None

S. Nagarakanti, None

M. Brown, None

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