1217. Infections Following Total Artificial Heart Placement
Session: Poster Abstract Session: Transplant: Epidemiology of Infections in Transplant Patients and Other Patients with Impaired Immunity
Friday, October 9, 2015
Room: Poster Hall

Background:

The Syncardia total artificial heart (TAH) provides biventricular replacement and is being used with increasing frequency as a bridge to orthotopic heart transplant (OHT). Immunologic changes after ventricular assist device placement have been described and may alter the risk of infections.

Methods:

Six adult cases since 2012 were reviewed to explore infections in the setting of TAH. Infections were defined as a positive culture or new physical finding. Due to widespread abnormalities on chest imaging, pneumonias were excluded in the absence of a documented pathogen.

Results:

Mean age was 46.7 and all cases were male. Indications for TAH included cardiac allograft vasculopathy and rejection (n=3) and ischemic & non-ischemic cardiomyopathy (n=3). Infection incidence was 100%, with a mean time to first infection of 59 days after TAH placement (range 12 – 112 days). Three cases developed >1 infection and 3 cases had a single infection. All patients received broad-spectrum antibiotics at the time of TAH placement. Three cases survived to OHT and 2 are awaiting OHT. One case suffered embolic strokes at days 11 and 43 after TAH and died.

Age

 Infections  (days after TAH)

 Outcome

1

56

 Clostridium difficile colitis (46)

 OHT

2

35

 Streptococcus viridans bacteremia (112)

 OHT

3

28

 Influenza A pneumonia (67)

 Respiratory syncytial virus bronchitis (471)

 Superficial thrombophlebitis (471)

 Awaiting OHT

4

38

 Candida kruseii fungemia (12)

 Klebsiella pneumoniae urinary tract infection (UTI) (12)

 Escherichia coli and Klebsiella pneumoniae UTI (77)

 Awaiting OHT

5

61

 Aspergillus ustus drive-line site infection (71)

 OHT

6

62

 Candida parapsilosis fungemia (49)

 Achromobacter xylosoxidans UTI (187)

 Death

Conclusion:

Persons who are TAH-dependent are at risk for the development of diverse infections, including both community-acquired and nosocomial pathogens. As opposed to the localized drive-line and pocket site infections seen with other ventricular assist devices, TAH-dependent persons developed infections at multiple sites. Controlled studies are needed as well as further investigation into the immunologic impact of device implantation.

Jonathan Baghdadi, MD1, Joanna Schaenman, MD PhD2, Jordan Lake, MD, MSc3, Theodoros Kelesidis, MD, PhD4, Margrit Carlson, MD5, Christopher Tymchuk, MD, PhD6 and Bernard M. Kubak, PhD, MD5, (1)Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, (2)Medicine/Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, (3)Department of Medicine, University of California, Los Angeles, Los Angeles, CA, (4)David Geffen School of Medicine at UCLA, Los Angeles, CA, (5)Medicine - Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, (6)Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA

Disclosures:

J. Baghdadi, None

J. Schaenman, None

J. Lake, Gilead Sciences: Consultant , Consulting fee
GlaxoSmithKline: Consultant and Investigator , Consulting fee and Research support

T. Kelesidis, None

M. Carlson, None

C. Tymchuk, None

B. M. Kubak, 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.