Staphylococcus aureus bloodstream infection in patients with ventricular assist devices–Management and outcome in a prospective bicenter cohort - 30/06/18
Highlights |
• | Time between VAD implantation and SAB onset was longer than previously reported. |
• | In 75% of cases VAD drivelines were the portal of entry. |
• | One third of VAD patients with SAB suffered from septic shock. |
• | All cause 30 day-mortality was 17% and, thus, comparable to SAB without VAD. |
• | Prompt and aggressive management may prevent dissemination and persistent infection. |
Summary |
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.
Le texte complet de cet article est disponible en PDF.Keywords : Driveline infection, Cardiac device infection, Bacteremia, Bloodstream infection, INSTINCT, Combination therapy, Biofilm
Abbreviations : BTT, CA-SAB, COHA-SAB, DDT, HA-SAB, INSTINCT, ID, SAB, VAD
Plan
Vol 77 - N° 1
P. 30-37 - juillet 2018 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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