F Nurozler1, M Argenziano, M C Oz, Y Naka. 1. Department of Surgery, College of Physicians & Surgeons of Columbia University, New York, New York, USA.
Abstract
BACKGROUND: Infection remains as the most serious complication and represents a significant threat to patients during long-term mechanical circulatory support. Fungal infection is a particularly worrisome complication and left ventricular assist device (LVAD) endocarditis does pose a serious threat. METHODS: One hundred and sixty-five patients underwent TCI Heartmate LVAD implantation between July 1991 and December 1999 at our institution. Detailed medical records were kept prospectively for all patients, and a variety of infection-related endpoints were analyzed on patients with fungal LVAD endocarditis. RESULTS: Thirty-seven patients (22%) developed fungal infections during LVAD support. Five (3%) of those met our criteria for the diagnosis of fungal LVAD endocarditis. Microbial portals of entry were identifiable in all cases. Infections were managed successfully in 4 patients (80%). CONCLUSIONS: The successful management of fungal LVAD endocarditis currently requires early recognition of potentially nonspecific signs and symptoms, and timely institution of antifungal therapy. In some cases with device-specific manifestations of LVAD endocarditis, device removal and replacement is necessary. In patients with clinical manifestations of sepsis and fungal driveline site or pocket infections without positive blood culture, urgent transplantation may be the appropriate management. In the setting of shortage in the donor supply, device removal and replacement is necessary.
BACKGROUND: Infection remains as the most serious complication and represents a significant threat to patients during long-term mechanical circulatory support. Fungal infection is a particularly worrisome complication and left ventricular assist device (LVAD) endocarditis does pose a serious threat. METHODS: One hundred and sixty-five patients underwent TCI Heartmate LVAD implantation between July 1991 and December 1999 at our institution. Detailed medical records were kept prospectively for all patients, and a variety of infection-related endpoints were analyzed on patients with fungal LVAD endocarditis. RESULTS: Thirty-seven patients (22%) developed fungal infections during LVAD support. Five (3%) of those met our criteria for the diagnosis of fungal LVAD endocarditis. Microbial portals of entry were identifiable in all cases. Infections were managed successfully in 4 patients (80%). CONCLUSIONS: The successful management of fungal LVAD endocarditis currently requires early recognition of potentially nonspecific signs and symptoms, and timely institution of antifungal therapy. In some cases with device-specific manifestations of LVAD endocarditis, device removal and replacement is necessary. In patients with clinical manifestations of sepsis and fungal driveline site or pocket infections without positive blood culture, urgent transplantation may be the appropriate management. In the setting of shortage in the donor supply, device removal and replacement is necessary.
Authors: Juhsien Jodi C Nienaber; Shimon Kusne; Talha Riaz; Randall C Walker; Larry M Baddour; Alan J Wright; Soon J Park; Holenarasipur R Vikram; Michael R Keating; Francisco A Arabia; Brian D Lahr; M Rizwan Sohail Journal: Clin Infect Dis Date: 2013-08-13 Impact factor: 9.079