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Abstract

Introduction: Implantations of left ventricular assist devices (LVADs) for end stage heart failure have more than doubled in the last three years. Over 50% of LVAD patients subsequently develop an infection due to their device, but there are no descriptions of the incidence, risk factors, or outcomes of multidrug resistant organisms (MDROs) in LVAD patients. Hypothesis: The objective of this study was to investigate the incidence, risk factors, and sequelae of MDROs in LVAD patients. We hypothesized that the development of an MDRO infection would lead to worse patient outcomes. Methods: This retrospective chart review examined 57 patients with permanent, continuous flow LVADs. MDROs were defined as organisms that were resistant to 2 or more classes of antibiotics. Outcomes measured included mortality, transplant, device removal, number of subsequent hospital admissions, and hospital admissions related to infection. Infections were categorized by the International Society of Heart and Lung Transplantation definitions. Multivariate regression was utilized to examine risk factors for MDRO infection. Results: 17 patients (28.9%) developed an MDRO infection. The most common MDRO was Staphylococcus aureus. Independent risk factors for MDROs were age at implant, days of hospitalization prior to implant, and exposed velour. We found a protective factor of cephalosporin use, specifically with 3rd generation cephalosporins. There were no significant differences in mortality, transplant, device explant, or hospital admissions between groups. There was a statistically significant increase in infection-associated hospital admissions in the patients who had MDRO infections. Conclusions: This analysis found an MDRO incidence of approximately 29% in LVAD patients. Independent risk factors for MDRO infections included age at implant, days of hospitalization prior to implant, and exposed velour. A protective factor was use of cephalosporins. Patients with MDRO infections had an increased number of infection-associated hospital admissions compared to those without MDROs.