1781. Infectious complications in children supported by ventricular assist devices (VAD) at Texas Children’s Hospital (TCH): a contemporary report
Session: Oral Abstract Session: Children Getting Sick from Healthcare Pediatric HAIs
Saturday, October 29, 2016: 11:00 AM
Room: 275-277
Background:

Limited data exist regarding infections and associated microbiology in pediatric VAD patients. We describe the associations and outcomes of infections in VAD patients at TCH.

Methods:

Retrospective review of long-term VAD patients at TCH from 1/2012-3/2016. Infections were categorized as non-VAD, VAD-specific, and VAD-related using the International Society for Heart and Lung Transplantation (ISHLT) definitions.

Results:

Forty-three VADs were implanted in 42 patients (mean age 8.1 yrs, range 4 mo - 26 yrs); 42 infections occurred in 23 (55%) patients. The overall rate of VAD infections (specific + related) was 3.2/1000 days of VAD support.

Factors associated with VAD infection included continuous-flow VAD (p=0.04) and absolute lymphocyte count < 1000/UL prior to surgery (p<0.01).

MSSA infection was associated with perioperative prophylaxis regimens that did not include 48 hours of cefazolin (p=0.05).

Four patients (9.5%) had invasive mold infections (all received fluconazole prophylaxis). Fungal infection was associated with total parental nutrition (p=0.03) and perioperative prophylaxis regimens that included 3rd/4thgeneration cephalosporins (p=0.04).

Of 9 deaths that occurred during VAD support, 4 (44%) were related to infection.

Conclusion:

Infections are an important cause of complications in pediatric VAD patients. The rate of infection in this cohort is lower than what has been published previously at TCH (3.2/1000 vs. 8/1000 days of VAD support), but optimal perioperative prophylaxis strategies still need to be defined.

Infection classification

Infection timing

Median (range)

Days of VAD support

Infection site

Organisms

Non-VAD

14 (0-507)

Respiratory 10

Urinary tract 5

Colitis 2

Chest tube 2

Pseudomonas aeruginosa (8)

Klebsiella spp. (3)

Clostridium difficile (2)

Aspergillusspp.

Citrobacter freundii

Enterobacter aerogenes

Enterococcus faecalis

VAD-related

50 (9-313)

Blood stream infection 8

Endocarditis 2

Pacemaker infection 1

MSSA (2)

P. aeruginosa (2)

E. aerogenes

E. faecalis

Fusarium pallidoroseum

Granulicatella adiacens

Proteus mirabilis *

Streptococcus mitis/oralis

Zygomycetes*

VAD-specific

124 (7-585)

Driveline 10

Pocket 1

Pump 1

CoNS (2)

MSSA (2)

Achromobacter xylosoxidans

Corynebacteriumspp.

Fungal hyphae*

Klebsiellaspp.

Nocardiaspp.*

P. aeruginosa

Polymicrobial

*Infection-related death

Claire E. Bocchini, MD1, Iki Adachi, MD2, Aamir Jeewa, MD2, Barbara Elias, RN3, Sebastian Tume, MD2, Jack Price, MD2 and Antonio Cabrera, MD2, (1)Pediatrics, Section of Infectious Disease, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, (2)Baylor College of Medicine and Texas Children's Hospital, Houston, TX, (3)Texas Children's Hospital, Houston, TX

Disclosures:

C. E. Bocchini, None

I. Adachi, None

A. Jeewa, None

B. Elias, None

S. Tume, None

J. Price, None

A. Cabrera, None

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