BACKGROUND: Ventricular assist devices (VAD) are currently approved for use as a bridge for transplantation. Although reports have suggested acceptable rates of survival of patients with VAD, there is little information regarding the mechanism and etiology of bacteremia in these patients. METHODS: We prospectively followed patients who underwent VAD implantation and developed bacteremia during VAD support at the University of Pittsburgh Medical Center. Relapsing bacteremia was defined as at least two episodes of positive blood cultures with a genetically related organism on 2 different days. Species identification and susceptibility testing were performed on all isolates. Pulse field gel electrophoresis was performed on selected blood and VAD isolates. RESULTS: Between January 1998 and August 1999, 3 patients with VAD developed relapsing bacteremia, which was treated with full courses of antibiotic agents, 2 of whom also developed VAD endocarditis. All 3 patients had documented driveline or device pocket infections with these isolates. Consecutive blood and VAD isolates were found to be genetically related within each patient. CONCLUSIONS: These patients with bacteremia after VAD implantation had relapse due to the same strain, which may have originated from indolent driveline infection. Endovascular infection in this setting is difficult to eradicate with antibiotic agents and carries a high mortality. These patients should be considered to have priority for orthotopic heart transplantation.
BACKGROUND: Ventricular assist devices (VAD) are currently approved for use as a bridge for transplantation. Although reports have suggested acceptable rates of survival of patients with VAD, there is little information regarding the mechanism and etiology of bacteremia in these patients. METHODS: We prospectively followed patients who underwent VAD implantation and developed bacteremia during VAD support at the University of Pittsburgh Medical Center. Relapsing bacteremia was defined as at least two episodes of positive blood cultures with a genetically related organism on 2 different days. Species identification and susceptibility testing were performed on all isolates. Pulse field gel electrophoresis was performed on selected blood and VAD isolates. RESULTS: Between January 1998 and August 1999, 3 patients with VAD developed relapsing bacteremia, which was treated with full courses of antibiotic agents, 2 of whom also developed VAD endocarditis. All 3 patients had documented driveline or device pocket infections with these isolates. Consecutive blood and VAD isolates were found to be genetically related within each patient. CONCLUSIONS: These patients with bacteremia after VAD implantation had relapse due to the same strain, which may have originated from indolent driveline infection. Endovascular infection in this setting is difficult to eradicate with antibiotic agents and carries a high mortality. These patients should be considered to have priority for orthotopic heart transplantation.
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
Authors: Carlos Arrecubieta; Faustino A Toba; Manuel von Bayern; Hirokazu Akashi; Mario C Deng; Yoshifumi Naka; Franklin D Lowy Journal: PLoS Pathog Date: 2009-05-01 Impact factor: 6.823
Authors: Sinal Patel; Syed Saif Abbas Rizvi; Jae Hwan Choi; Dylan P Horan; Matthew P Weber; Elizabeth J Maynes; Jessica G Y Luc; Nana Aburjania; John W Entwistle; Rohinton J Morris; Howard T Massey; Vakhtang Tchantchaleishvili Journal: Ann Cardiothorac Surg Date: 2019-11