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

Disclosures:

A. Patel, None

E. Bishburg, None

S. Nagarakanti, None

M. Brown, None

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.