Infections During Short-Term Mechanical Circulatory Support

Abstract

<h3>Purpose</h3> Infections remains a significant cause of death in short-term MCS patients. There is controversy regarding the indication and duration of antimicrobial (ATB) prophylaxis. We aimed to review our most recent experience and the impact of patient origin on the infection rate and prevalence of MDR bacterial (multi-resistant) colonization. <h3>Methods</h3> An observational retrospective study was conducted of all consecutive short-term support devices implanted inside a tertiary university hospital from 2014 - 2020 (n=57). Infection rate, clinical characteristics of infections, duration and type of AB prophylaxis, and prevalence of MDR bacterial colonization were recorded. As a secondary analysis, patients were divided into two groups according to the length of admission before support was initiated: Community acquired infections, when MCS was implanted less than three days from hospital admission (CO n=22) and Hospital-acquired infections, in patients with MCS implanted more than three days from hospital admission (H n=35). <h3>Results</h3> Fifty-seven patients were included, of which 77,2% were male. Medium age at implant was 54,3 years (SD 14 years). The most common etiology was ischemic heart disease, and the median LVEF was 20%. 95% of patients were on preoperative inotropes, and 38,6% were on ECLS support. 84,21% were intubated, and 47,36% were on renal replacement therapy.100% of patients received antibiotic prophylaxis, all covered gram-negative rods and gram-positive cocci including <i>MRSA</i>. Duration varied between 1 and 20 days. After classifying patients according to their preoperative length of stay, we found that in H patients infections were more frequent than in CO patients. The rate of MDR was also higher in the first group. It is noteworthy that all sternal infections happened after transplant and that in the Hospital-acquired group, sternal infections were fungal. There were no differences in survival. <h3>Conclusion</h3> There were no differences in antibiotic prophylaxis depending on the preimplant LOS. Most infections occurred once support had been removed and were more frequent after heart transplant. Mediastinitis is a rare complication, but post-transplant fungal infections may appear despite adequate antifungal prophylaxis. Further clinical studies are needed to reduce the risk of infection in short-term MCS patients.