Left ventricular assist device-related infections: a multicentric study

S. Simeon (1) , E. Flecher (1) , M. Revest (1, 2) , M. Niculescu (3) , J. -C. Roussel (4) , M. Michel (4) , P. Leprince (3) , P. Tattevin (1, 2)

1 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
2 Fonction, structure et inactivation d'ARN bactériens
3 Institut de cardiologie [CHU Pitié-Salpêtrière]
4 CHU Nantes - Centre Hospitalier Universitaire de Nantes

Objectives: The implantable left ventricular assist device (LVAD) is a major therapeutic development for end-stage heart failure in selected patients. As their use is expanding, infectious complications are emerging, with limited data available to guide their management. We aimed to better characterize LVAD-related infections.Methods: We enrolled all consecutive patients diagnosed with LVAD-related infections in three referral centres in France, using a standardized definition of infections in patients with LVAD. Data were collected from medical charts using a standardized questionnaire.Results: Between 2007 and 2012, 159 patients received LVAD for end-stage heart failure. Among them, 36 (22.6%; 5 women, 31 men) presented at least one infectious complication, after a median time of 2.9 months from LVAD implantation (interquartile range, 1.8-7.5), with a median follow up of 12 months (interquartile range 8-17). Main co-morbidities were alcoholism (33%), diabetes (11%) and immunosuppression (11%). Mean age at implantation was 51 (+/- 11) years. LVAD were implanted as bridge-to-transplantation (n=22), bridge-to-recovery (n=8), destination therapy (n=4), or unspecified (n=2). LVAD-related infections were restricted to the driveline exit site (n=17), had loco-regional extension (n=13), or reached the internal pump (n=3). The main bacteria isolated were Staphylococcus aureus (n=20), coagulase-negative staphylococci (n=7), Enterobacteriaceae (n=14), Pseudomonas aeruginosa (n=10) and Corynebacterium sp. (n=7), with polymicrobial infections in 19 cases. LVAD could be retained in all patients, with the use of prolonged antibacterial treatment in 34 (94%), and debridement in 17 (47%). One patient died due to LVAD-associated infection.Conclusions: LVAD-related infections are common after LVAD implantation, and may be controlled by prolonged antibiotic treatment. (C) 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Mots clés: heart transplant; heart failure; Foreign device; left ventricular assist device; Staphylococcus aureus

Domaines: Maladies infectieuses; Chirurgie; Santé publique et épidémiologie

S. Simeon, E. Flecher, M. Revest, M. Niculescu, J. -C. Roussel, et al.. Left ventricular assist device-related infections: a multicentric study. Clinical Microbiology and Infection, 2017, 23 (10), pp.748-751. ⟨10.1016/j.cmi.2017.03.008⟩. ⟨hal-01619296⟩