Persistent Blood Stream Infections Are Associated with Cerebrovascular Accidents in Patients with Continuous Flow LVADs

Trachtenberg, Barry; Aldeiri, Molham; Cordero‐Reyes, Andrea M.; Álvarez, Paulino; Bhimaraj, Arvind; Elias, Barbara; Suarez, E.E.; Bruckner, Brian A.; Loebe, Matthias; Harris, Richard L.; Zhang, Y.J.; Torre‐Amione, Guillermo; Estep, Jerry D.

doi:10.1016/j.healun.2014.01.086

Cited by 4 publications

(4 citation statements)

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“…Aldeiri et al 21 also reported an association between bloodstream infection, specifically Pseudomonas bacteremia, and stroke. The risk of increased mortality, stroke, and Pseudomonas bacteremia was also reported by Trachtenberg et al 22…”

Section: Resultssupporting

confidence: 71%

Left Ventricular Assist Device Infections: A Systematic Review

et al. 2018

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Left ventricular assist devices (LVADs) are becoming a more frequent life-support intervention. Gaining an understanding of risk factors for infection and management strategies is important for treating these patients. We conducted a systematic review and meta-analysis of studies describing infections in continuous-flow LVADs. We evaluated incidence, risk factors, associated microorganisms, and outcomes by type of device and patient characteristics. Our search identified 90 distinct studies that reported LVAD infections and outcomes. Younger age and higher body mass index were associated with higher rates of LVAD infections. Driveline infections were the most common infection reported and the easiest to treat with fewest long-term consequences. Bloodstream infections were not reported as often, but they were associated with stroke and mortality. Treatment strategies varied and did not show a consistent best approach. LVAD infections are a significant cause of morbidity and mortality in LVAD patients. Most research comes from secondary analyses of other LVAD studies. The lack of infection-oriented research leaves several areas understudied. In particular, bloodstream infections in this population merit further research. Providers need more research studies to make evidence-based decisions about the prevention and treatment of LVAD infections.

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Section: Resultssupporting

confidence: 71%

Left Ventricular Assist Device Infections: A Systematic Review

et al. 2018

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“…A systematic review by O’Horo et al 1 outlined 11 studies which described outcomes in LVAD patients with infections with variable results. Although multiple studies showed an increase in mortality with LVAD infections, 7,8 two studies showed increased hospital length of stay but no increase in mortality with bacteremia. 9,10…”

Section: Discussionmentioning

confidence: 96%

“…A systematic review by O'Horo et al 1 outlined 11 studies which described outcomes in LVAD patients with infections with variable results. Although multiple studies showed an increase in mortality with LVAD infections, 7,8 two studies showed increased hospital length of stay but no increase in mortality with bacteremia. 9,10 Furthermore, the optimal management strategy in these patients, including which patients should undergo LVAD exchange, is unclear, with limited published studies to guide current clinical practice.…”

Section: Discussionmentioning

confidence: 98%

Clinical Outcomes in Patients With Bacteremia and Concomitant Left Ventricular Assist Devices and Cardiac Implantable Electronic Devices

et al. 2023

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Infection remains a common cause of morbidity and mortality in patients with both left ventricular assist devices (LVADs) and cardiac implanted electronic devices (CIEDs) with limited data describing outcomes in patients who have both devices implanted. We performed a single-center, retrospective, observational cohort study of patients with both a transvenous CIED and LVAD who developed bacteremia. Ninety-one patients were evaluated. Eighty-one patients (89.0%) were treated medically and nine patients (9.9%) underwent surgical management. A multivariable logistic regression showed that blood culture positivity for >72 hours was associated with inpatient death, when controlled for age and management strategy (odds ratio [OR] = 3.73 [95% confidence interval {CI} = 1.34-10.4], p = 0.012). In patients who survived the initial hospitalization, the use of long-term suppressive antibiotics was not associated with the composite outcome of death or infection recurrence within 1 year, when controlled for age and management strategy (OR = 2.31 [95% CI = 0.88-2.62], p = 0.09). A Cox proportional hazards model showed that blood culture positivity for >72 hours was associated with a trend toward increased mortality in the first year, when controlled for age, management strategy, and staphylococcal infection (hazard ratio = 1.72 [95% CI = 0.88-3.37], p = 0.11). Surgical management was associated with a trend toward decreased mortality (hazard ratio = 0.23 [95% CI = 0.05-1.00], p = 0.05).

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“…It is possible that distal capillary networks are impacted by factors such as ongoing inflammation and endothelial cell changes related to a lack of pulsatility. Also, studies have suggested that pathogenspecific factors may contribute to the Pseudomonas bacterium's predilection for causing hemorrhagic strokes in CF-LVAD patients, 36 raising a possibility of antigen vascular interactions in the setting of CF physiology.…”

Section: Cerebral Functionmentioning

confidence: 99%