Article Dans Une Revue American Heart Journal Année : 2019

Risk factors and prognostic impact of left ventricular assist device–associated infections

1 Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes]
2 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
3 LTSI - Laboratoire Traitement du Signal et de l'Image
4 Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes]
5 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
6 CCV - Service Chirurgie Cardio-Vasculaire [CHU Toulouse]
7 Equipe "Obésité et insuffisance cardiaque: approches moléculaires et cliniques "
8 Adaptation cardiovasculaire à l'ischemie
9 UB - Université de Bordeaux
10 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
11 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
12 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
13 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
14 CHUGA - CHU de Grenoble-Alpes - Centre Hospitalier Universitaire CHU Grenoble
15 Hôpital Michallon
16 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
17 TIMONE - Hôpital de la Timone [CHU - APHM]
18 Hôpital Louis Pradel [CHU - HCL]
19 Service de Cardiologie [CHU Rouen]
20 Service de chirurgie cadiovasculaire et thoracique [Rouen]
21 CHU Caen Normandie - CHU Caen Normandie – Centre Hospitalier Universitaire de Caen Normandie
22 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
23 CHU Henri Mondor [Créteil]
24 Service de cardiologie
25 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
26 CHU Clermont-Ferrand
27 Service Chirurgie Cardio-Vasculaire [CHU Clermont-Ferrand]
28 HEGP - Hôpital Européen Georges Pompidou [APHP]
29 Service de Chirurgie Cardiaque et Transplantations - Hôpital Brabois
30 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
31 Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy]
Romain Eschalier

Résumé

Background - Left ventricular assist device (LVAD)-associated infections may be life-threatening and impact patients' outcome. We aimed to identify the characteristics, risk factors, and prognosis of LVAD-associated infections. Methods - Patients included in the ASSIST-ICD study (19 centers) were enrolled. The main outcome was the occurrence of LVAD-associated infection (driveline infection, pocket infection, or pump/cannula infection) during follow-up. Results - Of the 652 patients enrolled, 201 (30.1%) presented a total of 248 LVAD infections diagnosed 6.5 months after implantation, including 171 (26.2%), 51 (7.8%), and 26 (4.0%) percutaneous driveline infection, pocket infection, or pump/cannula infection, respectively. Patients with infections were aged 58.7 years, and most received HeartMate II (82.1%) or HeartWare (13.4%). Most patients (62%) had implantable cardioverter-defibrillators (ICDs) before LVAD, and 104 (16.0%) had ICD implantation, extraction, or replacement after the LVAD surgery. Main pathogens found among the 248 infections were Staphylococcus aureus (n = 113' 45.4%), Enterobacteriaceae (n = 61; 24.6%), Pseudomonas aeruginosa (n = 34; 13.7%), coagulase-negative staphylococci (n = 13; 5.2%), and Candida species (n = 13; 5.2%). In multivariable analysis, HeartMate II (subhazard ratio, 1.56; 95% CI, 1.03 to 2.36; P = .031) and ICD-related procedures post-LVAD (subhazard ratio, 1.43; 95% CI, 1.03-1.98; P = .031) were significantly associated with LVAD infections. Infections had no detrimental impact on survival. Conclusions - Left ventricular assist device-associated infections affect one-third of LVAD recipients, mostly related to skin pathogens and gram-negative bacilli, with increased risk with HeartMate II as compared with HeartWare, and in patients who required ICD-related procedures post-LVAD. This is a plea to better select patients needing ICD implantation/replacement after LVAD implantation.

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hal-02151624 , version 1 (23-06-2020)

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Pierre Tattevin, Erwan Flécher, Vincent Auffret, Christophe Leclercq, Stéphane Boulé, et al.. Risk factors and prognostic impact of left ventricular assist device–associated infections. American Heart Journal, 2019, 214, pp.69-76. ⟨10.1016/j.ahj.2019.04.021⟩. ⟨hal-02151624⟩
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