Endocarditis in left ventricular assist device

Thyagarajan, Braghadheeswar; Kumar, Monisha Priyadarshini; Sikachi, Rutuja R.

doi:10.5582/irdr.2016.01049

Cited by 18 publications

(11 citation statements)

References 37 publications

(57 reference statements)

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“…As there are no established standardized diagnostic criteria to diagnose LVAD-associated endocarditis, a combination of tests can be used to increase diagnostic yield (24). These tests include blood cultures, imaging studies and cultures from explanted LVADs ( Table 1).…”

Section: Discussionmentioning

confidence: 99%

Management and outcomes of left ventricular assist device-associated endocarditis: a systematic review

Patel

Rizvi

Choi

et al. 2019

Ann. Cardiothorac. Surg.

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Background: Left ventricular assist device (LVAD)-associated endocarditis remains poorly studied, especially in newer continuous-flow LVADs (CF-LVADs). The aim of this review was to assess outcomes of patients with LVAD-associated endocarditis, as stratified by CF-LVAD and pulsatile LVAD (P-LVAD) use as well as by different interventions and pathogen types.Methods: An electronic search was performed to identify studies in the English literature on LVADassociated endocarditis.Results: Overall, 16 articles with 26 patients were included; seven had CF-LVADs and 19 had P-LVADs; time to development of endocarditis was 91 days (152 vs. 65 days, respectively, P=0.05). Eleven of 25 patients were treated with antibiotics only. Remaining 14 patients received antibiotics, however, they also underwent additional surgical intervention. One patient was treated with embolization alone for mycotic aneurysm and was therefore excluded. At a median follow-up time of 344 days post implant, there was no difference in overall mortality between CF-LVAD and P-LVAD-associated endocarditis patients (57.9% vs. 42.9%, P=0.81). Patients who underwent additional surgical intervention had higher overall survival compared to those treated with antibiotics alone (71.4% vs. 27.3%, P=0.07); with no difference in outcomes amongst those who underwent surgical device exchange as compared to heart transplantation (80.0% vs. 66.7%; P=0.23)Conclusions: Compared to patients with P-LVADs, CF-LVAD patients appeared to be resistant to early development of LVAD-associated endocarditis. There was a trend towards high survival observed amongst patients who underwent additional surgical intervention as compared to those treated with antibiotics alone, with no difference amongst surgical device exchange as compared to heart transplantation. Advantages of additional surgical intervention vs. medical therapy alone deserves further exploration to determine its applicability in CF-LVADs.

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Section: Discussionmentioning

confidence: 99%

Management and outcomes of left ventricular assist device-associated endocarditis: a systematic review

Patel

Rizvi

Choi

et al. 2019

Ann. Cardiothorac. Surg.

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“…Candida albicans, C. parapsilosis and S. racemosum were isolated in 3, 1 and 1 case respectively. More recently in the continuous flow era, LVAD associated endocarditis has been defined as "clinical evidence of pump and/or cannula infection along with the presence of vegetations on echocardiography or a vascular phenomenon as defined by modified Duke's criteria" ( [26] and reviewed in [42]). Staphylococcus aureus (MRSA, MSSA) predominates, as well as CNS (MRSE, MSSE) and Pseudomonas aeruginosa (reviewed in [42]).…”

Section: Infective Endocarditis and Pump/cannula Infectionsmentioning

confidence: 99%

“…More recently in the continuous flow era, LVAD associated endocarditis has been defined as "clinical evidence of pump and/or cannula infection along with the presence of vegetations on echocardiography or a vascular phenomenon as defined by modified Duke's criteria" ( [26] and reviewed in [42]). Staphylococcus aureus (MRSA, MSSA) predominates, as well as CNS (MRSE, MSSE) and Pseudomonas aeruginosa (reviewed in [42]). Cases of linezolid resistant Streptococcus sanguinis [52] and Listeria monocytogenes [53] with associated leukocytoclastic vasculitis have also been reported.…”

Section: Infective Endocarditis and Pump/cannula Infectionsmentioning

confidence: 99%

“…In a large prospective study of infections after cardiac operations, Perrault et al found that LVAD and transplant patients experienced 5.8 times higher rates of mediastinal infections (95% CI 2.36-14.33) with five times higher readmission and mortality rates [83]. Nearly all cases of LVAD endocarditis will require explanation and replacement of the device as well as prolonged antimicrobial therapy, and the risks associated with these [42]. Outcomes are improving overall however.…”

Section: Outcomes In Lvad Infectionsmentioning

confidence: 99%

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Left Ventricular Assist Device Infections

Skalweit¹

2018

Advanced Concepts in Endocarditis

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Left ventricular assist device (LVAD) infections are important causes of morbidity and mortality in patients who receive these mechanical circulatory supports as a bridge to transplantation (BTT) or as destination therapy (DT) (for individuals who are not candidates for cardiac transplant). Infections are more common among persons who received pulsatile flow LVADs as opposed to newer continuous flow (CF) devices. Other risk factors for infection include obesity, renal failure, depression and immunosuppression. An LVAD infection increases the risk of infections in persons who undergo cardiac transplantation. Infections include percutaneous site, driveline, pump pocket and pump/cannula infections; sepsis, bacteremia, mediastinitis and endocarditis. Diagnosis is achieved by monitoring LVAD flow parameters and observing typical clinical and laboratory manifestations of infection. Imaging such as PET-CT or SPECT-CT imaging can be helpful to establish a diagnosis of pump pocket infection. Echocardiography may aid in detecting native valve endocarditis and thrombus associated with the LVAD. The most common pathogens include Staphylococcus, Corynebacterium, Enterococcus, Pseudomonas and Candida spp. Treatment requires targeted antimicrobials plus surgical debridement of infected tissue and device components. In cases of pump/cannula/LVAD endocarditis, especially if fungal pathogens or Mycobacterium chimaera are involved, LVAD removal/reimplantation vs. transplant is necessary, combined with extended antimicrobial therapy.

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“…Staphylococcus aureus is the most common causative organism of LVAD-associated infections, along with coagulasenegative staphylococci (Nienaber et al, 2013). While LVADassociated endocarditis is not common, the condition is difficult to cure and its mortality appears to reach as high as 50% (Thyagarajan et al, 2016). The case of a patient with LVADassociated endocarditis involving multiple clones of S. aureus is presented here.…”

Section: Introductionmentioning

confidence: 98%

Left ventricular assist device-associated endocarditis involving multiple clones of Staphylococcus aureus with distinct antimicrobial susceptibility patterns

Harada

Aoki

Okamoto

et al. 2019

International Journal of Infectious Diseases

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A B S T R A C TThe case of a patient with left ventricular assist device (LVAD)-associated endocarditis involving multiple clones of Staphylococcus aureus is presented. Different clones with distinct colony morphology were identified from blood cultures collected on the same day and showed diverse antimicrobial resistance patterns. In addition, a difference in antimicrobial susceptibility was observed even within an identical clone recovered 400 days apart due to the loss of SCCmec for methicillin and modification of the 23S rRNA target site for linezolid during a long-term treatment course.

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Endocarditis in left ventricular assist device

Cited by 18 publications

References 37 publications

Management and outcomes of left ventricular assist device-associated endocarditis: a systematic review

Management and outcomes of left ventricular assist device-associated endocarditis: a systematic review

Left Ventricular Assist Device Infections

Left ventricular assist device-associated endocarditis involving multiple clones of Staphylococcus aureus with distinct antimicrobial susceptibility patterns

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