1470. Epidemiology of Initial and Recurrent Episodes of Infection in Left Ventricular Assist Device (VAD) Recipients
Session: Poster Abstract Session: HAI: Surgical Site Infections
Friday, October 28, 2016
Room: Poster Hall
Posters
  • IDweekposter.pdf (245.8 kB)
  • Background: As many as 50% of VAD recipients develop infection. These are challenging infections and recurrences or relapses are common. However, there are few data on incidence of recurrent or relapsed infections and its effects on outcomes.  

    Methods: We conducted a single center retrospective cohort study of VAD patients from 2013-2015.  A VAD infection episode was defined from first report of symptoms to time of symptom improvement or clearance of cultures for a minimum of 72h. Recurrence at the same site with the same microorganism was classified as relapse. VAD infections were categorized with the criteria by the International Society for Heart and Lung Transplantation (ISHLT). Non VAD infections were defined by the Center for Disease Control/National Healthcare Safety Network (CDC/NHSN) surveillance definitions.

    Results: A total of 158 individual patients were reviewed. 90 patients (56.9%) had at least 1 episode of infection, 65.5% non VAD related and 34.5% due to VAD infection. Most common site of VAD infection was superficial driveline in 32.0%, followed by VAD related blood stream infection (BSI) in 17.0%. The most common non VAD infection in the first episode was tracheobronchitis (39.4%).  56.7% of the patients with a first VAD infection went on to develop relapses.  The VAD diagnoses more commonly associated with relapse were superficial driveline infections (47.1%), VAD related mediastinitis (12.0%) and VAD related bloodstream infection (12.0%). Staphylococcus aureus was present in 36.5% of all relapses, followed by Enterobacteriaceae (22.0%), skin flora (13.4%) and Pseudomonas aeruginosa (10.8%). For patients with a single episode, the predominant organisms associated with VAD infection were skin flora (36.4%). In patients with multiple episodes, VAD infection in the first episode was due to Staphylococcus aureus in 66.7% of cases.

    Conclusion: Recurrent infections in VAD recipients are common, with frequent relapses in patients with an initial VAD infection. The microbiology of the initial infection may be an important predictor of relapse, as VAD infections with Staphylococcus aureus and the Enterobacteriaceae during the first episode were more frequently associated with relapse.

     

    Merilda Blanco Guzman, MD, Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO, Erik R. Dubberke, MD, MSPH, FIDSA, FSHEA, Washington University School of Medicine, St. Louis, MO, Margaret a. Olsen, PhD, MPH, Infectious Diseases, Washington University School of Medicine, St. Louis, MO, Justin Vader, MD, MPHS, Division Cardiovascular Medicine, Washington University School of Medicine, St Louis, MO and David Raymer, MD, Division of Carviovascular Medicine, Washington University School of Medicine, St Louis, MO

    Disclosures:

    M. Blanco Guzman, None

    E. R. Dubberke, Rebiotix Inc.: Investigator and Scientific Advisor , Consulting fee and Research support
    Merck: Consultant and Investigator , Consulting fee and Research support
    Sanofi Pasteur: Consultant and Grant Investigator , Consulting fee and Grant recipient
    Summitt: Consultant , Consulting fee

    M. A. Olsen, Sanofi Pasteur: Consultant and Grant Investigator , Consulting fee and Research grant
    Pfizer: Consultant and Scientific Advisor , Consulting fee

    J. Vader, None

    D. Raymer, None

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