2013. Bloodstream Infections in Advanced Heart Failure Patients Requiring Prolonged Use of Axillary Intra-Aortic Balloon Pumps - A Single Center Study

Abstract

Abstract Background Bloodstream infections (BSI) impact outcomes in critically ill patients. Institutions and quality and performance improvement efforts to minimize catheter associated infections are valued to optimize outcomes. While intra-aortic balloon pumps (IABP) implanted through the axillary route have been recently used in cardiogenic shock patients for prolonged support, the incidence and associated significance of BSI remains unknown in this cohort. The aim of this study was to assess the incidence of BSI in patients with axillary-placed IABP and evaluate its impact on patient outcomes. Methods We retrospectively reviewed 141 patients that underwent axillary IABP placement from May 2016 through August 2020. The primary endpoint was the incidence of BSI during axillary IABP, reported as the proportion of patients who developed a BSI and BSI per 1000-device days. Results BSI occurred in 13% of patients and accounted for 4.3 infections per 1000-device days. Prior femoral device use and longer duration of axillary IABP support occurred more frequently in the BSI cohort. Presence of traditional BSI risk factors including central line days, use of parenteral nutrition, and prior positive cultures did not differ between those who developed BSI and those who did not. The rate of end-outcome attainment (transplant, LVAD, recovery) was not statistically different in those that developed BSI vs not (72% vs 88% p=0.08). A total of 41% of BSI were caused by Staphylococcus epidermidis. Use of peri-procedural antimicrobials was associated with lower risk of BSI development (24% vs 8%; p=0.01) Conclusion Patients in cardiogenic shock requiring use of life-saving temporary mechanical support pose a challenge to maintain free of BSI during prolonged support with an indwelling catheter that allows for ambulation and movement. Mitigation of modifiable BSI risk factors, such as the use of peri-procedural antimicrobial prophylaxis, accompanied by a low threshold for screening and treatment are reasonable strategies to improve patient outcomes. Future research is needed to further evaluate BSI risk in this patient population and its subsequent impact on patient outcomes. Disclosures All Authors: No reported disclosures.