Analysis of Breakthrough Blood Stream Infections in Left Ventricular Assist Device Recipients Managed with Chronic Antimicrobial Suppressive Therapy
Left Ventricular Assist Devices (LVAD) associated infections are associated with 5 folds higher 1-year mortality. Published literature is insufficient to inform clinicians regarding optimal management of bloodstream infection (BSI) in patients LVAD recipients. In particular, it is unclear which episodes of BSI may result in occult hematogenous seeding of the device surfaces, and therefore should be managed with chronic suppressive therapy (CAS). We aim to describe BSI , CAS, and breakthrough BSI in our LVAD population.
We retrospectively reviewed 332 episodes of all LVAD infections at Mayo Clinic from 2007-2015. We categorized BSI as LVAD related/associated and LVAD non-related as defined by established criteria in the cardiac device literature. Our primary outcome was to describe breakthrough BSI in LVAD related and non-related infections in patients receiving CAS and those who were not.
We identified 68 episodes of bacteremia in our LVAD population. Of these, 55 were proven BSI (see Fig 1). In our study cohort, 45/55 (82%) were male and median patient age was 62 years. A majority of LVAD implants were destination therapy 34/55 (62%) and 35/55(64%) had a central line in place at the time of BSI. Twenty patients had non-VAD related BSI and 9 of these (9/20, 45%) patients were placed on CAS with 2 of these (2/9, 22%) had subsequent breakthrough BSI, whereas 11/20 (55%) were not placed on CAS with no breakthrough infections seen (Fig 1).
Our preliminary data suggests that routine use of CAS for non-VAD related BSI is not necessary as only a minority go on to have breakthrough BSI. Limiting unnecessary use of antibiotics will have significant implications for stewardship and preventing emergence of resistance.
A. J. Wright, None
R. C. Walker, None
J. Stulak, None
A. Bran, None
L. M. Baddour, UpToDate: Collaborator , Royalty payment .
S. Farid, None
M. R. Sohail, TyRx Inc: Investigator , Research support . Medtronic Inc: Investigator , Research support . Medtronic Inc: Consultant , Speaker honorarium . Spectranetics: Consultant , Speaker honorarium . Boston Scientific Corp: Consultant , Speaker honorarium .
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