Persistent Blood Stream Infection in Patients Supported With a Continuous-Flow Left Ventricular Assist Device Is Associated With an Increased Risk of Cerebrovascular Accidents

被引:73
作者
Trachtenberg, Barry H. [1 ,2 ]
Cordero-Reyes, Andrea M. [1 ]
Aldeiri, Molham [1 ,3 ]
Alvarez, Paulino [1 ]
Bhimaraj, Arvind [1 ,2 ]
Ashrith, Guha [1 ,2 ]
Elias, Barbara [2 ]
Suarez, Erik E. [1 ]
Bruckner, Brian [1 ,2 ]
Loebe, Matthias [1 ,2 ]
Harris, Richard L. [4 ]
Zhang, J. Yi [5 ]
Torre-Amione, Guillermo [1 ,6 ]
Estep, Jerry D. [1 ,2 ]
机构
[1] Houston Methodist Hosp, Houston Methodist DeBakey Heart & Vasc Ctr, Houston, TX USA
[2] Houston Methodist Hosp, Houston Methodist JC Walter Jr Transplant Ctr, Houston, TX USA
[3] Univ Texas Med Branch, Dept Cardiol, Galveston, TX 77555 USA
[4] Houston Methodist, Dept Infect Dis, Houston, TX USA
[5] Houston Methodist, Dept Neurol Surg, Houston, TX USA
[6] Tecnol Monterrey, Catedra Cardiol & Med Vasc, Monterrey, Mexico
关键词
Left ventricular assist device; cerebrovascular accident; Pseudomonas aeruginosa; infection; CIRCULATORY SUPPORT; NEUROLOGIC COMPLICATIONS; BRAIN INFARCTION; STROKE;
D O I
10.1016/j.cardfail.2014.10.019
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Common adverse events in patients supported with Continuous-flow left ventricular assist devices (CF-LVAD) include infections and cerebrovascular accidents (CVA). Some studies have suggested a possible association between blood stream infection (BSI) and CVA. Methods and Results: Medical records of patients who received Heartmate II (HMII) CF-LVADs in 2008-2012 at a single center were reviewed. CVA was categorized as either hemorrhagic (HCVA) or ischemic (ICVA). BSI was divided into persistent (pBSI) and nonpersistent (non-pBSI). pBSI was defined as BSI with the same organism on repeated blood culture >72 hours from initial blood culture despite antibiotics. Univariate and multivariate analyses were performed to determine predictors. A total of 149 patients had HMII implanted; 76% were male, and the overall mean age was 55.4 +/- 13 years. There were a total of 19 (13%) patients who had CVA (7 HCVA and 12 ICVA) at a median of 295 days (range 5-1,096 days) after implantation. There were a total of 28 (19%) patients with pBSI and 17 (11%) patients with non-pBSI. Patients with pBSI had a trend toward greater BMI (31 kg/m(2) vs 27 kg/m(2); P = .09), and longer duration of support (1,019 d vs 371 d; P < .001) compared with those with non-pBSI. Persistent BSI was associated with an increased risk of mortality and with all-cause CVA on multivariate analysis (odds ratio [OR] 5.97; P = .003) as well as persistent Pseudomonas aeruginosa infection (OR 4.54; P = .048). Conclusions: Persistent BSI is not uncommon in patients supported by CF-LVAD and is highly associated with all-cause CVA and increased all-cause mortality.
引用
收藏
页码:119 / 125
页数:7
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