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

• Published in: Journal of cardiac failure Vol. 21; no. 2; pp. 119 - 125
• Main Authors: Trachtenberg, Barry H., Cordero-Reyes, Andrea M., Aldeiri, Molham, Alvarez, Paulino, Bhimaraj, Arvind, Ashrith, Guha, Elias, Barbara, Suarez, Erik E., Bruckner, Brian, Loebe, Matthias, Harris, Richard L., Zhang, J. Yi, Torre-Amione, Guillermo, Estep, Jerry D.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2015
• Subjects: Adult; Aged; Bacteremia - diagnosis; Bacteremia - mortality; Cardiovascular; cerebrovascular accident; Equipment Contamination; Female; Heart-Assist Devices - adverse effects; Heart-Assist Devices - microbiology; Humans; infection; Left ventricular assist device; Male; Middle Aged; Mortality - trends; Postoperative Complications - diagnosis; Postoperative Complications - microbiology; Postoperative Complications - mortality; Pseudomonas aeruginosa; Pseudomonas aeruginosa - isolation & purification; Retrospective Studies; Risk Factors; Stroke - diagnosis; Stroke - microbiology; Stroke - mortality; Left ventricular assist device; Pseudomonas aeruginosa; infection; cerebrovascular accident
• ISSN: 1071-9164; 1532-8414; 1532-8414
• DOI: 10.1016/j.cardfail.2014.10.019

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. 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/m2 vs 27 kg/m2; 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). Persistent BSI is not uncommon in patients supported by CF-LVAD and is highly associated with all-cause CVA and increased all-cause mortality. [Display omitted] •We found that 30% of CF-LVAD patients developed bacteremia, and 19% of these had persistent BSI.•Persistent BSI is associated with all-cause CVA and mortality in patients on CF-LVAD support.•Persistent BSI is more associated with all-cause CVA in CF-LVAD patients than traditional risk factors such as age, atrial fibrillation, HTN.•Pseudomonas aeruginosa BSI was an independent risk factor for CVA, particularly hemorrhagic CVA.•Three of the seven patients with HCVA had a mycotic aneurysm demonstrated on cerebral angiography.