2025. Outcomes of Pseudomonas aeruginosa Ventricular Assist Device Infection

Abstract

Abstract Background Ventricular assist device (VAD) infections caused Pseudomonas aeruginosa (PA) are difficult to treat given limited antibiotic options, development of resistance and biofilm formation in the presence of retained hardware. We looked at outcomes of patients who developed Pseudomonas aeruginosa LVAD infection (PA-LVADI) Methods Single center retrospective study of patients older than 18 years who received LVAD from 7/1/2007 to 2/1/2021 and subsequently developed PA-LVADI. Patients with proven or probable VAD-specific infections: driveline infection (DLI), pump pocket, and pump/cannula infections were included. The cumulative incidences of death, transplant, and LVAD explant, following Pseudomonas aeruginosa infection, were evaluated as competing outcomes. Fig 1:Classification of Pseudomonas aeruginosa LVAD Infections at diagnosisFigure 3:Cumulative incidence of death, transplant, or explant following Pseudomonas aeruginosa LVAD infection Results 51 patients with VAD-specific PA-LVADI were identified (Fig 1). Median age at the time of first LVAD placement was 55 years (23 – 74). Of the 28 patients ever listed for transplant, 13 (46%) received heart transplant, 8 (29%) were delisted, 7 (25%) were alive on transplant list (Fig 2). The median number of days from LVAD placement to first PA infection was 587 (54 – 3389). 30 (59%) had PA as the first causative organism. The extent of first PA-LVADI was superficial DLI in 43(84%), deep DLI in 5 (10%), pump pocket in 2(4%) and pump/cannula in 1(2%). 46 (90%) of patients received intravenous (IV) therapy with median duration of 84 (2 – 525) total IV antibiotic days. Antibiotic resistance emerged in 25/51 (49%) patients, with 32% being multi-drug resistant (MDR). Surgery was performed in 30 (58%). 12/13 who received heart transplants were followed for at least 1 year post-transplant and all were alive. 5 of the remaining 38 patients underwent pump exchange or explant. 20/38 (53%) of patients who were not transplanted died (Fig 3). Conclusion This is the largest study on PA-LVADI to date. We noted significant morbidity and mortality, with 90% of patients requiring prolonged IV antibiotics and over half requiring surgical treatment. Drug resistance emerged in a significant proportion of patients. Survival after transplant was excellent, but by 2 years of infection over half of the patients have been transplanted, explanted, or died. Disclosures All Authors: No reported disclosures.