Cannula Infection Research Articles

Nutritional status and cannula infections in pediatric patients on ventricular assist device support.

Ventricular assist devices (VADs) are used to bridge pediatric patients to heart transplantation. Paracorporeal VADs require the placement of cannulas, which can create an environment for infections. We examined cannula infections in pediatric VAD patients and the role of nutritional status. This retrospective study (2005-2021) included patients <20 years old on VAD support using Berlin Heart EXCOR® cannulas. Cannula infections were defined by a positive culture and need for antibiotic therapy. Malnutrition was defined using the American Society of Parenteral and Enteral Nutrition guidelines as well as the Michigan MTool. There were 76 patients with a median age at implant of 0.9 years (IQR 0.4, 3.6), 50% male, with 73.7% having non-congenital heart disease. More than one-quarter (26.3%) of patients developed a cannula infection. Higher pre-implant weight (OR = 1.93, p = 0.05), creatinine (OR = 1.02, p = 0.044), and pre-albumin (OR = 15.79, p = 0.025), as well as duration of VAD support (OR = 1.01; p = 0.003) were associated with increased odds of developing a cannula infection. There was no difference in the malnutrition parameters between those with and without an infection. Further exploration in a larger cohort is needed to see whether these associations remain and if the incorporation of objective measures of nutritional status at the time of infection are predictive.

Cold atmospheric plasma therapy as a novel treatment for Berlin Heart EXCOR pediatric cannula infections

Cold atmospheric plasma therapy as a novel treatment for Berlin Heart <scp>EXCOR</scp> pediatric cannula infections

Pharmacokinetic/pharmacodynamic of ceftobiprole in patients on ECMO.

Due to its bacteriological spectrum and efficacy in skin and soft tissue infections, ceftobiprole may be of interest for extracorporeal membrane oxygenation (ECMO) cannula-related infection. Whether or not ceftobiprole pharmacokinetic is changed by ECMO is not known. We performed a retrospective monocentric cohort study of 35 patients with suspected ECMO-related cannula infections (28 on ECMO, 7 after ECMO removal), who received ceftobiprole as empiric treatment, and had ceftobiprole blood levels measured at trough, peak and CT50 (50% of the dosing interval). Ceftobiprole blood levels of the 28 patients on ECMO were compared to those of the seven patients without ECMO. We also explored factors associated with low ceftobiprole trough level. Among the 35 patients included, 29 had a confirmed cannula-related infection and 48 pathogens were isolated. Ceftobiprole minimum inhibitory concentration (MIC) was determined in 29 out of these 48, and 23 (79%) were susceptible to ceftobiprole. Ceftobiprole blood levels (at trough, peak and CT50) were similar in ECMO and non-ECMO patients. Moreover, in patients whose pathogens responsible for infection were susceptible to ceftobiprole, 94% had a ceftobiprole trough level above the MIC. Ceftobiprole blood levels were decreased in patients with acute renal failure requiring renal replacement therapy (RRT) and in patients with increased renal clearance (defined as a creatinine clearance >130 ml/min), independently of ECMO. No other factor was associated with modification of ceftobiprole PK/PD. Ceftobiprole PK/PD is not different in patients during ECMO or after its withdrawal. Factors associated with decreased ceftobiprole blood levels were patients requiring RRT and patients with increased renal clearance.

Nutritional Status and Cannula Infections in Pediatric VAD Patients

<h3>Purpose</h3> Ventricular assist devices (VADs) have emerged as an effective treatment option to bridge pediatric patients to heart transplantation. Paracorporeal VADs require the placement of an inflow and outflow cannula, which can create an environment for infections. We aimed to characterize cannula infections in pediatric VAD patients and examine the impact of nutritional status. <h3>Methods</h3> This was a single-center retrospective study (2005-2020) of all patients <20 years old implanted with a VAD using Berlin Heart cannulas. A cannula infection was defined by symptoms in the presence of a positive culture and the need for antibiotic therapy. Malnutrition was defined as per the ASPEN guidelines. <h3>Results</h3> There were 54 patients eligible for the study. The median age at implant was 0.9 years (IQR 0.3, 4.1), 59% were male, with the most common etiology being non-congenital heart disease (67%). The median time on VAD support was 89.5 days (IQR 34.3, 174.8). During the study period, 29.6% of patients developed a cannula infection with a median time to infection of 52 days (IQR 23.3, 109.0). There was no difference in terms of pre-VAD weight, height, malnutrition scores, BMI or albumin levels between patients with and without a cannula infection. However, lower pre-VAD pre-albumin levels was associated with cannula infections (p=.022), as was older age (p=.048). Seventy-five percent (n= ¾) of the patients with a g-tube developed a cannula infection and almost 75% of patients who developed a cannula infection were malnourished based on their pre-VAD weight z-scores. <h3>Conclusion</h3> Less than one-third of pediatric VAD patients with Berlin cannulas developed a cannula infection. Pre-VAD pre-albumin levels and older age were associated with the development of a cannula infection. In addition, the majority of the children with an infection were malnourished, suggesting that pre-implant nutritional status may be a modifiable risk factor. These results suggest a relationship between nutritional status and infection that warrants further study in the pediatric VAD population.

Extracorporeal Membrane Oxygenation Cannula-Related Infections: Epidemiology and Risk Factors.

Although being a potential major source of infection in extracorporeal membrane oxygenation (ECMO) patients, data regarding cannula-related infections (CRI) remain scarce. We therefore aimed at describing the epidemiology of CRI among critically ill patients supported by ECMO. Between October 2017 and November 2019, adult patients supported by either venoarterial (VA), venopulmonary arterial, or venovenous (VV) ECMO for more than 24 hours were prospectively enrolled. When CRI was suspected, cannula swab and subcutaneous needle aspirate samples were obtained for microbiological culture. Cannula tips were systematically sent for culture at the time of ECMO removal. Primary end-point was CRI, which was defined by sepsis or local sign of cannula infection and at least one positive culture among swab, subcutaneous needle aspirate or tip. Multivariate analysis was performed to identify risk factors of CRI. Hundred patients were included, including 77 VA, 12 venopulmonary arterial, and 11 VV ECMO. Cannula-related infections were diagnosed after a median duration of ECMO of 10 [7-13] days. Rate of CRI was 24%, including 10% with bacteremia. Most frequent involved pathogens were Enterobacteriaceae (n = 14), Enterococci (n = 8), and coagulase-negative Staphylococci (n = 7). By multivariate analysis, diabetes and ECMO duration were independently associated with CRI.

Assessment of Nurses’ Knowledge towards Infections of Peripheral Intravenous Cannula in Al-Basrah Teaching Hospital

Aimed at assessing nurse’s knowledge regarding infection of the peripheral cannula. Descriptive, hospitalbased study was conducted in Al-Basrah city in Al-Basrah Teaching Hospital from October 24th, 2019, to June 11th, 2020. The study included nurses in the hospital; they were (60) nurses. The instrument used for the study was a self-administrated questionnaire; the data were presented in a pre-designed questionnaire firstly. The questionnaire consisted of two parts: socio-demographic characteristics and knowledge about the infection of a peripheral intravenous cannula. Inferential and descriptive statistics have been utilized for the analysis of data. Data were analyzed manually and then through the use of the statistical package for social science (SPSS, v. 23). The results of the study present that the high percent (61.7%) of the study sample are male, (66.7%) of them at the (20-29) year age group, ( 45.0%) of them nursing institute, (61.7% ) their years of work experience were arranged between (1-9 year), most of them (60.0%) don’t have previous training about cannula infection. There has been a significant correlation between nurses’ knowledge, previous training in infection of a peripheral cannula, and level of education, and there has not been any significant correlation between nurses’ knowledge and nurses’ gender, age group, and years of experience. Recommendation: This study recommended establishing a regular training program and workshops about infection control measures, especially for an invasive procedure

Left ventricular assist device-associated infections: incidence and risk factors.

BackgroundLeft ventricular assist device (LVAD)-associated infections are major complications that can lead to critical outcomes. The aims of this study were to assess the incidence of and to determine the risk factors for LVAD-associated infections.MethodsWe included all consecutive patients undergoing LVAD implantation between January 1, 2010, and January 1, 2019, in a single institution. Infection-related data were retrospectively collected by review of patient’s medical files. LVAD-associated infections were classified into three categories: percutaneous driveline infections, pocket infections and pump and/or cannula infections.ResultsWe enrolled 72 patients. Twenty-one (29.2%) patients presented a total of 32 LVAD-associated infections. Eight (38.1%) patients had more than one infection. Five (62.5%) pocket infections and one (50.0%) pump and/or cannula infection were preceded by a driveline infection. The median delay between the operation and LVAD-associated infection was 6.5 (1.4–12.4) months. The probability of having a LVAD-associated infection at one year after receiving an implant was 26.6% (95% CI: 17.5–40.5%). Percutaneous driveline infections represented 68.7% of all LVAD-associated infections. Staphylococcus aureus and coagulase-negative staphylococci were the predominant bacteria in LVAD-associated infections (53.1% and 15.6%, respectively). Hospital length of stay (sdHR =1.22 per 10 days; P=0.001) and postoperative hemodialysis (sdHR =0.17; P=0.004) were statistically associated with infection. Colonization with multidrug-resistant bacteria was more frequent in patients with LVAD-associated infections than in others patients (42.9% vs. 15.7%; P=0.013).ConclusionsLVAD-associated infections remain an important complication and are mostly represented by percutaneous driveline infections. Gram-positive cocci are the main pathogens isolated in microbiological samples. Patients with LVAD-associated infections are more frequently colonized with multidrug-resistant bacteria.

Current results of left ventricular assist device therapy in France: the ASSIST-ICD registry.

Our goal was to provide a picture of left ventricular assist device (LVAD) activity in France between 2007 and 2016 based on the multicentric ASSIST-ICD registry. We retrospectively collected 136 variables including in-hospital data, follow-up survival rates and adverse events from 671 LVAD recipients at 20 out of 24 LVAD implant centres in France. The average follow-up time was 1.2 years (standard deviation: 1.4); the total follow-up time was 807.5 patient-years. The included devices were the HeartMate II®, HeartWare LVAS® or Jarvik 2000®. The overall likelihood of being alive while on LVAD support or having a transplant (primary end point) at 1, 2, 3 and 5 years postimplantation was 65.2%, 59.7%, 55.9% and 47.7%, respectively, given a cumulative incidence of 29.2% of receiving a transplant at year 5. At implantation, 21.5% of patients were on extracorporeal life support. The overall rate of cardiogenic shock at implantation was 53%. The major complications were driveline infection (26.1%), pump pocket or cannula infection (12.6%), LVAD thrombosis (12.2%), ischaemic (12.8%) or haemorrhagic stroke (5.4%; all strokes 18.2%), non-cerebral haemorrhage (9.1%) and LVAD exchange (5.2%). The primary end point (survival) was stratified by age at surgery and by the type of device used, with inference from baseline profiles. The primary end point combined with an absence of complications (secondary end point) was also stratified by device type. The ASSIST-ICD registry provides a real-life picture of LVAD use in 20 of the 24 implant centres in France. Despite older average age and a higher proportion of patients chosen for destination therapy, survival rates improved compared to those in previous national registry results. This LVAD registry contrasts with other international registries because patients with implants have more severe disease, and the national policy for graft attribution is distinct. We recommend referring patients for LVAD earlier and suggest a discussion of the optimal timing of a transplant for bridged patients (more dismal results after the second year of support?).

Association of Infections in Patients Supported with Left Ventricular Assist Device with Vasoplegia and Post-Cardiac Transplant Outcomes

Background LVAD-specific infections (LSI) are common in patients on LVAD support. The impact of LSI on post-heart transplant (HT) outcomes is not clear. We hypothesized that LSI are associated with higher rates of acute renal failure (ARF), rejection and mortality in the first year post-HT with perioperative vasoplegia serving as a mediating factor. Methods A retrospective analysis at our institution was conducted for all LVAD patients from 10/2012 to 9/2017 who received HT. Total artificial heart patients were excluded. LSI was defined as driveline infection, pump pocket, pump or cannula infection. Vasoplegia was considered present if the following criteria were met: epinephrine/norepinephrine ≥ 150 ng/kg/min, dopamine ≥ 10 ug/kg/min or vasopressin ≥ 4 U/hr at any time point or duration of inotropic support > 14 days with a cardiac index > 2.1 L/min/m2 and systemic vascular resistance less than 15 mmHg), or any use of methylene blue or vitamin B12 complex. The primary outcome was a composite of ARF, rejection (antibody-mediated or acute cellular rejection ≥ 2R or hemodynamic compromise), and mortality in the first year post-HT. Results A total of 105 patients were bridged to HT with LVAD therapy. Of these, 63 (60%) had evidence of an LSI pre-HT with a majority (92%) being driveline-associated. These patients were more likely to be men (85% vs 69%), have higher BSA (2.05 m2 vs 1.89 m2), and be UNOS 1A (97% vs 64%), but no differences were noted in BMI, etiology of cardiomyopathy, device type, duration on LVAD support, or medical therapy. Among patients with LSI, there was an equal distribution of gram positive and negative organisms identified and 56% were on oral antibiotics vs 41% on IV antibiotics. The incidence of vasoplegia in the overall cohort was 12% (13/105), with 16% (10/63) in the LSI group vs 7% (3/42) in the no LSI group (p=0.183). Over half of the patients (56/105) experienced a composite of ARF, rejection or death post HT, 59% (37/63) in the LSI group vs 45% (19/42) in the no LSI group (p=0.175). Similarly, there was no difference in the individual components of the composite outcomes or in the secondary outcome hospital length of stay. Conclusions In our cohort, LSI were common among LVAD patients but not associated with vasoplegia or the clinical outcome of ARF, graft rejection, or mortality in the first year post HT. This may be limited by a small sample size.

PIN2 BACTERIAL INFECTIONS CAUSED BY INTRAVENOUS SUPPLIES

Blood stream infections (BSIs) caused by intravenous tools are more and more common iatrogenic complications. Infections related to cannulas, especially high morbidity ratio, lethality around 25%, protracted hospitalization and elevated costs are inherent in BSIs. The aim of this study was to assess the detection of health workers according to the emergence of phlebitis’ risk factors, and to map the nurses’ awareness of new protocols and supplies. A descriptive, quantitative, cross-sectional study was carried out within nurses working in a university clinic’s different departments (internal medicine, surgery, intensive care) and in a city hospital’s departments (internal medicine, surgery) between 06.14.2018.-09.05.2018. Assessment was made with a self-made questionnaire that contained questions about socio-demographic data, general knowledge (protocol of hand disinfection, types of peripheral cannulas, bandages, symptoms of phlebitis, pathogens) and tasks related to cannulation of peripheral veins. We calculated descriptive statistics and χ2-test (p<0.05). Results were calculated with Microsoft Excel and SPSS Statistics 20.0. 79.6% of respondents think that peripheral venous cannulas should be changed in every 72 hours, according to an old protocol. Regarding to transparent film dressing, 55.4% of respondents say that it must be changed as regularly as generic gauze dressing. Workers older than 50 years are significantly less aware than their younger colleagues (p=0.02). There was no significant difference between departments and health institutions in the results of knowledge test (number of points) (p>0.05). Health workers are competent in detecting risk factors and early symptoms of phlebitis, however their knowledge is less sufficient about new protocols and supplies. Cannula infections can harden the everyday of health care. Training nurses regularly is important, so their knowledge can unify regardless to work experience and educational attainment, and they can be informed about newest protocols and the proper use of modern tools.

Epidemiology, Outcomes, and Effects of Device Flow Type on Ventricular Assist Devices (VAD) Infections: An IMACS Registry Analysis

Purpose Infection remains an important cause of morbidity and mortality in continuous flow ventricular assist device (CF-VAD) recipients. It is unclear if flow type (axial or centrifugal) is associated with VAD infection and post-infection outcomes. This study aimed to investigate the device flow-type-specific rates of VAD infection and subsequent outcomes. Methods We analyzed IMACS adult patients with CF-LVADs from 2013-2017. We defined VAD infection using the ISHLT definitions as both VAD-specific infections including driveline, pump pocket/interior/exit cannula infection, and VAD-related infections including mediastinitis and VAD-related bloodstream infection. We compared the rates of VAD infections and post-infection events by flow type. Results Patients with axial devices (N=9988) had both higher early ( 3 months) rates (per 100 patient-months) of developing VAD infections compared to those with centrifugal (N=5572; Early: 2.3 vs. 1.8, p Conclusion VAD infection rates were higher in axial devices both in the early and late time periods following device implant; younger patients had a higher hazard of VAD infection in this group. VAD infection was associated with higher bleeding and mortality in both flow type groups. Infection prevention programs specifically targeting VAD infections should be a key component of VAD research.

Epidemiology of infection in mechanical circulatory support: A global analysis from the ISHLT Mechanically Assisted Circulatory Support Registry.

Despite advances in device technology and treatment strategies, infection remains a major cause of adverse events (AEs) in mechanical circulatory support (MCS) patients. To characterize the epidemiology of MCS infection, we examined the type, location, and timing of infection in the International Society for Heart and Lung Transplantation Registry (ISHLT) for Mechanically Assisted Circulatory Support (IMACS) over 3 years, 2013 to 2015. Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) definitions were used to categorize AE infections occurring in MCS patients within IMACS. The IMACS infection variables were mapped to ISHLT definitions for infection where feasible. Three categories of MCS infection were defined as ventricular assist device (VAD) specific, VAD related, and non-VAD. There were 10,171 patients enrolled from January 2013 through December 2015. Infection was the most common AE, with 3,788 patients (37%) experiencing ≥ 1 infection, and 6,758 AE infections reported overall. Non-VAD infection was the largest category, 4,501: 34.0% pneumonias, 30.6% non-VAD-related bloodstream infections (BSIs), 24.15% urinary tract infections (UTIs), and 10.2% gastrointestinal infections. VAD-specific infection was the second largest category, 1,756: 82.9% driveline, 12.8% pocket, and 4.3% pump/or cannula infections. VAD-related infection was the smallest category, 501: 47.5% BSIs, 47.5% mediastinitis, and 5.0% mediastinitis/pocket infections. All 3 categories were more frequently reported ≤ 3 months after implant. Non-VAD infection, including pneumonia, BSI, UTI, and gastrointestinal infection, was the leading category of infection in MCS patients and the most frequently reported ≤ 3 months after implant. These results provide evidence to support resourcing and strengthening infection prevention strategy early after implantation in MCS.

Infections in patients after Berlin Heart® EXCOR assist device implantation.

Berlin Heart® EXCOR devices (BHED) are ventricular assist devices (VAD) used mainly as a bridge to heart transplantation (HT) in pediatric population. The aim of our study is to report the infections diagnosed in adult patients undergoing a BHED implantation. Adult patients receiving a BHED between Jul 2009 and Oct 2017 at our institution were included. Infections were classified according to the International Society of Heart and Lung Transplantation definitions in VAD-Specific (VAD-S), VAD-Related (VAD-R) and non-VAD (N-VAD). Fifteen patients underwent BHED implantation, which was maintained for a mean of 92 (19-195) days. Infection occurred in 13 patients who developed 36 infectious episodes: 5 VAD-S (5 cannula infections); 8 VAD-R (5 bloodstream infections and 3 mediastinitis) and 24N-VAD (7 urinary tract infections, 6 Cytomegalovirus diseases and others). Overall, 27 (75%) were bacterial, 7 (19.4%) were viral and there was one (2.7%) fungal infection. Eleven patients underwent HT and all of them developed at least one infection after it. In 3 cases, all VAD-R or VAD-S infections were caused by the same etiology as before HT. Their median time of appearance was on day +6 (3-11) after BHED removal and HT. Overall mortality was 6/15 (40%). None of the deaths were related to VAD Infection. Infection complicated BHED implantation in 86.7% of the patients. Overall, 13.9% were specific of BHED and 22.2% were related. However, infections did not preclude HT in any case and carried no attributable mortality.

Nosocomial Infections During Extracorporeal Membrane Oxygenation: Incidence, Etiology, and Impact on Patients' Outcome.

To study incidence, type, etiology, risk factors, and impact on outcome of nosocomial infections during extracorporeal membrane oxygenation. Retrospective analysis of prospectively collected data. Italian tertiary referral center medical-surgical ICU. One hundred five consecutive patients who were treated with extracorporeal membrane oxygenation from January 2010 to November 2015. None. Ninety-two patients were included in the analysis (48.5 [37-56] years old, simplified acute physiology score II 37 [32-47]) who underwent peripheral extracorporeal membrane oxygenation (87% veno-venous) for medical indications (78% acute respiratory distress syndrome). Fifty-two patients (55%) were infected (50.4 infections/1,000 person-days of extracorporeal membrane oxygenation). We identified 32 ventilator-associated pneumonia, eight urinary tract infections, five blood stream infections, three catheter-related blood stream infections, two colitis, one extracorporeal membrane oxygenation cannula infection, and one pulmonary-catheter infection. G+ infections (35%) occurred earlier compared with G- (48%) (4 [2-10] vs. 13 [7-23] days from extracorporeal membrane oxygenation initiation; p < 0.001). Multidrug-resistant organisms caused 56% of bacterial infections. Younger age (2-35 years old) was independently associated with higher risk for nosocomial infections. Twenty-nine patients (31.5%) died (13.0 deaths/1,000 person-days of extracorporeal membrane oxygenation). Infected patients had higher risk for death (18 vs. 8 deaths/1,000 person-days of extracorporeal membrane oxygenation; p = 0.037) and longer ICU stay (32.5 [19.5-78] vs. 19 [10.5-27.5] days; p = 0.003), mechanical ventilation (36.5 [20-80.5] vs. 16.5 [9-25.5] days; p < 0.001), and extracorporeal membrane oxygenation (25.5 [10.75-54] vs. 10 [5-13] days; p < 0.001). Older age (> 50 years old), reason for connection different from acute respiratory distress syndrome, higher simplified acute physiology score II, diagnosis of ventilator-associated pneumonia, and infection by multidrug-resistant bacteria were independently associated to increased death rate. Infections (especially ventilator-associated pneumonia) during extracorporeal membrane oxygenation therapy are common and frequently involve multidrug-resistant organisms. In addition, they have a negative impact on patients' outcomes.

Application of transparent film dressing in fistula nursing of patients with PCN

Objective To evaluate the clinical application effect of transparent film dressing in fistula nursing of patients with percutanueous nephrostomy (PCN). Methods By using before-after self control study method, 40 patients with pelvic tumor that caused by postrenal renal failure, and needed long-term fistula remained after PCN surgery were selected as the research object. Conventional sterile gauze and tape were used to nurse the fistula before intervention and transparent film dressing was used after intervention. Results Patents always worried about trachea cannula exodus and infection before intervention. After intervention, the comfort degree of their daily life (like showering, sleeping and daily activities) was obviously higher than that before intervention (P<0.01). The incidence of renal fistula local adverse effect after intervention is relatively low. And the difference was statistically significant (P<0.01). Before intervention, the tape was loosing in (5.47±1.48) days, there were three cases of accidental trachea cannula exodus; and after intervention, transparent film dressing hemmed in (14.22±1.99) days, and no accidental trachea cannula exodus occurred (P<0.01); and no hyper-sensitive cases happened with the transparent film dressing. Conclusions The transparent film dressing has the advantages of stable viscosity, waterproofing, fungi-proofing, breathability and hypoallergenic, etc. It can well protect and fix the fistula, and it is suitable for nursing care of patients with long-term renal fistula. Key words: Nephrostomy, percutaneous; Renal fistula; Transparent film dressing; Comfort degree

New Treatment for Percutaneous Sites in Patients with a Ventricular Assist Device: Nihon University Crystal Violet Method.

Infection of the percutaneous site of a ventricular assist device (VAD) is a challenging complication. We report our experience with crystal violet Solbase (Nihon University crystal violet method) for prevention of driveline or cannula infections in VAD patients. The crystal violet method was used in 10 patients (prophylaxis in nine and treatment in one). Eight patients had an extracorporeal VAD (Nipro) and two had an implantable VAD (Heart Mate II). The infection-free period was 4-623 days (mean: 144.2 ± 222.9 days). All eight patients with an extracorporeal VAD died, while the two patients with an implantable VAD (Heart Mate II) survived. Infection was improved in a patient with MRSA, and the results of bacteriological examination were always negative in the patients receiving prophylaxis. The two patients with an implantable VAD had no infection for 2 and 20 months after implantation. These findings suggest that the Nihon University crystal violet method is effective for prevention and treatment of driveline or cannula infections in patients with a VAD.

Importance of Early Appropriate Intervention Including Antibiotics and Wound Care for Device-Related Infection in Patients With Left Ventricular Assist Device

IntroductionA left ventricular assist device (LVAD) is essential for treating patients with advanced heart failure. However, LVAD-related infection is a significant cause of mortality and morbidity, with bloodstream infection (BSI) especially associated with high mortality. We investigated the incidence of infectious complications in patients who received an LVAD and evaluated the effects of early and appropriate intervention for LVAD-related infection. MethodWe retrospectively reviewed 27 consecutive patients who underwent continuous-flow LVAD (CF-LVAD; n = 16) or pulsatile-flow LVAD (PF-LVAD; n = 11) implantation at the National Cerebral and Cardiovascular Center between April 2011 and March 2013. Incidences of LVAD-related infections, such as drive-line infection in patients with CF-LVAD, cannula infection in patients with PF-LVAD, and BSI in patients with both types, were examined (follow-up period, 342 ± 229 days). The mandatory antibiotic prophylaxis protocol at our institution includes teicoplanin (400 mg) 2 days before LVAD implantation and doripenem (1000 mg) within 1 hour of skin incision. In addition, the driveline exit sites undergo sterile cleansing with diluted hydrogen peroxide and placement of an antimicrobial occlusive dressing for wound care, with dressing changes performed 2–3 times per day. ResultsMore than 90% of all patients suffered from a drive-line infection within 12 months after LVAD implantation. However, BSI developed in only 12.5% of CF-LVAD and 10% of PF-LVAD patients within 12 months (log-rank test; P = .875). ConclusionsLVAD-related infections, such as drive-line and cannula infections, were common, whereas the incidence of BSI was low in our LVAD-implanted patients. Our results highlight the importance of early and appropriate intervention including antibiotics and wound care for device-related infections for reducing the incidence of potentially fatal BSI.

Current concepts in the diagnosis and management of left ventricular assist device infections

Left ventricular assist devices (LVAD) are increasingly being used both as a bridge to transplantation and for long-term myocardial surrogate destination therapy in patients with end-stage heart failure. Primarily owing to the presence of a driveline that connects the device to an external battery through an open skin incision, the rates of LVAD-related infections (LVADRIs) are high, ranging from 30 to 50%. LVADRIs can be broadly classified into driveline infection, pump pocket infection, bloodstream infection and endocarditis/pump or cannula infection. Diagnostic evaluation and management of these complicated infections can be quite challenging for clinicians involved in the care of these patients. Here, the authors summarize the current epidemiology, microbiology, diagnostic approach and management strategies for each type of LVADRI. The authors also review current concepts regarding antibiotic prophylaxis for LVAD implantation. Finally, the authors highlight the gaps in the knowledge of LVADRI and provide directions for future studies.

Nosocomial Infections in Adult Cardiogenic Shock Patients Supported by Venoarterial Extracorporeal Membrane Oxygenation

Incidence and impact on adult patients' outcomes of nosocomial infections (NIs) occurring during venoarterial extracorporeal membrane oxygenation (VA-ECMO) support for refractory cardiogenic shock have rarely been described. We retrospectively reviewed the charts of a large series of patients who received VA-ECMO in our intensive care unit (ICU) from January 2003 through December 2009. Incidence, types, risk factors, and impact on outcomes of NIs occurring during ECMO support were analyzed. Among 220 patients (49 ± 16 years old, simplified acute physiology score (SAPS) II 61 ± 20) who underwent ECMO support for >48 hours for a total of 2942 ECMO days, 142 (64%) developed NIs. Ventilator-associated pneumonia (VAP), bloodstream infections, cannula infections, and mediastinitis infections occurred in 55%, 18%, 10% and 11% of the patients, respectively. More critical condition at ICU admission, but not antibiotics at the time of ECMO cannulation, was associated with subsequently developing NIs (hazard ratio, 0.73; 95% confidence interval [CI], .50-1.05; P = .09). Infected patients had longer durations of mechanical ventilation, ECMO support, and hospital stays. Independent predictors of death were infection with severe sepsis or septic shock (odds ratio, 1.93; 95% CI, 1.26-2.94; P = .002) and SAPS II, whereas immunosuppression and myocarditis as the reason for ECMO support were associated with better outcomes. Cardiogenic shock patients who received the latest generation VA-ECMO still had a high risk of developing NIs, particularly VAP. Strategies aimed at preventing these infections may improve the outcomes of these critically ill patients.

1350: Nursing intervention on a cardiology ward can reduce peripheral intravenous cannula related complications and infections

1350: Nursing intervention on a cardiology ward can reduce peripheral intravenous cannula related complications and infections