Saima Aslam1, Rongbing Xie2, Jennifer Cowger3, James K Kirklin4, Vivian H Chu5, Stephan Schueler6, Theo de By7, Kate Gould8, Orla Morrissey9, Lars H Lund10, Stanley Martin11, Daniel Goldstein12, Margaret Hannan13. 1. Division of Infectious Diseases, Department of Medicine, University of California, San Diego, La Jolla, California. Electronic address: saslam@ucsd.edu. 2. James and John Kirklin Institute for Research in Surgical Outcomes (KIRSO), Division of Cardiothoracic Surgery, Department of Surgery, The University of Alabama at Birmingham, Alabama. 3. Division of Cardiovascular Medicine, Henry Ford Hospitals, Detroit, Michigan. 4. Division of Cardiothoracic Surgery. Director, Kirklin Institute for Research in Surgical Outcomes (KIRSO), Department of Surgery, University of Alabama at Birmingham, Alabama. 5. Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina. 6. Department of Cardiothoracic Surgery, Newcastle Hospitals NHS Foundation Trust, Newcastle, United Kingdom. 7. QUIP Project Manager, EUROMACS Managing Director, EUROMACS, Berlin, Germany. 8. Department of Microbiology, Newcastle Hospitals NHS Foundation Trust, Newcastle, United Kingdom. 9. Department of Infectious Diseases, Alfred Health, Melbourne, Australia. 10. Unit of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. 11. Division of Infectious Diseases. Geisinger Health System, Danville, Pennsylvania. 12. Department of Cardiothoracic Surgery, Montefiore Medical Center, New York, New York. 13. Division of Infectious Diseases, Mater Miscordiae University Hospital, Dublin, Ireland.
Abstract
BACKGROUND: We used multicenter international data from the International Society of Heart and Lung Transplantation Mechanically Assisted Circulation Support (IMACS) registry to determine bloodstream infection (BSI) event rate, independent risk factors, and association with mortality. METHODS: Included were patients registered in IMACS from January 2013 through December 2015, assessed BSI event rate of mechanical circulatory support (MCS) and non-MCS-related BSIs, and conducted univariate and multivariate analyses between BSI with baseline characteristics and mortality. RESULTS: We documented 1,606 BSIs in 1,231 of 10,171 MCS recipients (12%), with an event rate of 2.43 BSIs/100 patient-months within 3 months after implant (early onset) and 1.03 BSIs/100 patient-months after 3 months (late onset). Of these episodes, 1,378 (85.8%) were non- MCS-related BSI. Increasing body mass index and bilirubin were independent correlates of MCS-related BSI. Independent correlates of non-MCS-related BSI included older age, higher body mass index, previous cardiac surgery, baseline chronic renal disease and dialysis, pre-implant frailty, presence of biventricular assist device, total artificial heart or right ventricular assist device, and Interagency Registry for Mechanically Assisted Circulatory Support category 1. Survival after 3 months after implant of patients who developed early-onset BSI was 56.9% at 24 months vs 77.4% in patients without early-onset BSI (p < 0.001). Early-onset BSI was an independent correlate of mortality at 3 months after implantation (hazard ratio, 2.56; 95% confidence interval, 2.09-3.15; p < 0.001). CONCLUSIONS: Early-onset BSI was associated with significantly increased 24-month mortality. More than 85% of these BSIs were not device related. There is an opportunity for infection prevention practices to decrease the BSI event rate, which may affect 24-month survival. These data can also serve as benchmarking for individual institutions.
BACKGROUND: We used multicenter international data from the International Society of Heart and Lung Transplantation Mechanically Assisted Circulation Support (IMACS) registry to determine bloodstream infection (BSI) event rate, independent risk factors, and association with mortality. METHODS: Included were patients registered in IMACS from January 2013 through December 2015, assessed BSI event rate of mechanical circulatory support (MCS) and non-MCS-related BSIs, and conducted univariate and multivariate analyses between BSI with baseline characteristics and mortality. RESULTS: We documented 1,606 BSIs in 1,231 of 10,171 MCS recipients (12%), with an event rate of 2.43 BSIs/100 patient-months within 3 months after implant (early onset) and 1.03 BSIs/100 patient-months after 3 months (late onset). Of these episodes, 1,378 (85.8%) were non- MCS-related BSI. Increasing body mass index and bilirubin were independent correlates of MCS-related BSI. Independent correlates of non-MCS-related BSI included older age, higher body mass index, previous cardiac surgery, baseline chronic renal disease and dialysis, pre-implant frailty, presence of biventricular assist device, total artificial heart or right ventricular assist device, and Interagency Registry for Mechanically Assisted Circulatory Support category 1. Survival after 3 months after implant of patients who developed early-onset BSI was 56.9% at 24 months vs 77.4% in patients without early-onset BSI (p < 0.001). Early-onset BSI was an independent correlate of mortality at 3 months after implantation (hazard ratio, 2.56; 95% confidence interval, 2.09-3.15; p < 0.001). CONCLUSIONS: Early-onset BSI was associated with significantly increased 24-month mortality. More than 85% of these BSIs were not device related. There is an opportunity for infection prevention practices to decrease the BSI event rate, which may affect 24-month survival. These data can also serve as benchmarking for individual institutions.
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