Insa Joost1, Wolfgang Bothe2, Christine Pausch3, Achim Kaasch4, Berit Lange1, Gabriele Peyerl-Hoffmann1, Greta Flüh4, Matthias Müller1, Christian Schneider5, Harald Seifert6, Winfried V Kern1, Friedhelm Beyersdorf2, Siegbert Rieg7. 1. Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany. 2. Department of Cardiovascular Surgery, Heart Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany. 3. Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, 04107 Leipzig, Germany. 4. Institute of Medical Microbiology and Hospital Hygiene, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany. 5. Institute of Medical Microbiology, Immunology and Hygiene, University Medical Center Freiburg, 79106 Freiburg, Germany. 6. Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, 50937 Cologne, Germany; German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Germany. 7. Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany. Electronic address: siegbert.rieg@uniklinik-freiburg.de.
Abstract
OBJECTIVES: Ventricular assist devices (VAD) are increasingly implanted in patients with terminal heart failure. Here we describe the clinical course, management and outcome of VAD patients with S. aureus bloodstream infection (SAB). METHODS: We conducted a post hoc analysis of data from 1073 patients who had been prospectively enrolled in two consecutive SAB bicenter cohort studies. Patients with VAD in situ at the onset of SAB were identified. Follow-up of patients was at least 90 days. RESULTS: Twelve VAD patients with SAB were identified. Compared to the overall cohort, patients with VAD presented more often with fever (92% vs. 65%) and septic shock (33% vs. 23%) and showed higher C-reactive protein levels (mean 244 vs. 132 g/ml). The median time to onset of SAB after device implantation was 161 days (range 24-790 days). 30-day mortality was comparable to the whole cohort (17% vs. 19%). Infection-related surgical interventions were performed in six patients. Hematogenous dissemination to distant foci was not found in any patient. One out of nine surviving patients required continuous suppressive antibiotic therapy. CONCLUSIONS: Mortality rates for VAD patients with SAB were comparable to SAB without VAD. No hematogenous disssemination or persistent infections were recorded, which might be associated with the prompt and aggressive antibiotic and surgical management in VAD patients. SAB per se does not preclude successful transplantation.
OBJECTIVES: Ventricular assist devices (VAD) are increasingly implanted in patients with terminal heart failure. Here we describe the clinical course, management and outcome of VAD patients with S. aureus bloodstream infection (SAB). METHODS: We conducted a post hoc analysis of data from 1073 patients who had been prospectively enrolled in two consecutive SAB bicenter cohort studies. Patients with VAD in situ at the onset of SAB were identified. Follow-up of patients was at least 90 days. RESULTS: Twelve VAD patients with SAB were identified. Compared to the overall cohort, patients with VAD presented more often with fever (92% vs. 65%) and septic shock (33% vs. 23%) and showed higher C-reactive protein levels (mean 244 vs. 132 g/ml). The median time to onset of SAB after device implantation was 161 days (range 24-790 days). 30-day mortality was comparable to the whole cohort (17% vs. 19%). Infection-related surgical interventions were performed in six patients. Hematogenous dissemination to distant foci was not found in any patient. One out of nine surviving patients required continuous suppressive antibiotic therapy. CONCLUSIONS: Mortality rates for VAD patients with SAB were comparable to SAB without VAD. No hematogenous disssemination or persistent infections were recorded, which might be associated with the prompt and aggressive antibiotic and surgical management in VAD patients. SAB per se does not preclude successful transplantation.
Authors: Howard Y Park; Stephen D Zoller; Vishal Hegde; William Sheppard; Zachary Burke; Gideon Blumstein; Christopher Hamad; Marina Sprague; John Hoang; Ryan Smith; Francisco Romero Pastrana; Julie Czupryna; Lloyd S Miller; Marina López-Álvarez; Mafalda Bispo; Marleen van Oosten; Jan Maarten van Dijl; Kevin P Francis; Nicholas M Bernthal Journal: Sci Rep Date: 2021-01-15 Impact factor: 4.379