Risk factors and outcomes of fungal Ventricular-Assist device infections

Saima Aslam, Maria Del Pilar Hernandez, John Thornby, Barry Zeluff, Rabih O. Darouiche

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

Background. Infection is a common complication of ventricular-assist devices (VADs) and is associated with rehospitalization, thromboembolic events, VAD malfunction, delay in heart transplantation, and a high mortalityrate. The objectives of this study were to investigate the frequency of fungal VAD infections and assess various risk factors and their effects on mortality as compared with bacterial VAD infections. Methods. We conducted a retrospective chart review of patients with infected VADs at a single tertiary care center. The frequency, risk factors, and outcomes of fungal versus bacterial VAD infections were compared. Results. Of the 300 patients who received a VAD, 108 (36%) developed VAD infection, including 85 bacterial and 23 fungal infections. Most common bacterial causes of infection were Staphylococcus aureus, coagulase-negative staphylococci, enterococci, and Pseudomonas aeuruginosa. The most common fungal etiologic agent was Candida albicans. Only the use of total parenteral nutrition was associated with the development of a fungal VAD infection in multivariate analysis (odds ratio, 6.95; 95% confidence interval, 1.71-28.16; P = .007). Patients who experienced fungal VAD infection were less likely to be cured (17.4% vs 56.3%; P = .001) and had greater mortality (91% vs 61%; P = .006), compared with those who experienced bacterial VAD infection. Conclusions. Fungi were responsible for approximately one-fifth of VAD infections and were associated with a mortality rate of 91%. Restriction of total parenteral nutrition use is essential in decreasing the rate of fungal VAD infection. Trials are needed for investigating the use of echinocandins or lipid formulations of amphotericin B for prevention and/or treatment of fungal VAD infection.

Original languageEnglish (US)
Pages (from-to)664-671
Number of pages8
JournalClinical Infectious Diseases
Volume50
Issue number5
DOIs
StatePublished - Mar 1 2010
Externally publishedYes

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Heart-Assist Devices
Infection
Total Parenteral Nutrition
Mortality
Echinocandins
Mycoses
Coagulase
Enterococcus
Amphotericin B
Heart Transplantation
Pseudomonas
Candida albicans
Staphylococcus
Bacterial Infections
Tertiary Care Centers
Staphylococcus aureus

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

Cite this

Aslam, S., Del Pilar Hernandez, M., Thornby, J., Zeluff, B., & Darouiche, R. O. (2010). Risk factors and outcomes of fungal Ventricular-Assist device infections. Clinical Infectious Diseases, 50(5), 664-671. https://doi.org/10.1086/650454

Risk factors and outcomes of fungal Ventricular-Assist device infections. / Aslam, Saima; Del Pilar Hernandez, Maria; Thornby, John; Zeluff, Barry; Darouiche, Rabih O.

In: Clinical Infectious Diseases, Vol. 50, No. 5, 01.03.2010, p. 664-671.

Research output: Contribution to journalArticle

Aslam, S, Del Pilar Hernandez, M, Thornby, J, Zeluff, B & Darouiche, RO 2010, 'Risk factors and outcomes of fungal Ventricular-Assist device infections', Clinical Infectious Diseases, vol. 50, no. 5, pp. 664-671. https://doi.org/10.1086/650454
Aslam S, Del Pilar Hernandez M, Thornby J, Zeluff B, Darouiche RO. Risk factors and outcomes of fungal Ventricular-Assist device infections. Clinical Infectious Diseases. 2010 Mar 1;50(5):664-671. https://doi.org/10.1086/650454
Aslam, Saima ; Del Pilar Hernandez, Maria ; Thornby, John ; Zeluff, Barry ; Darouiche, Rabih O. / Risk factors and outcomes of fungal Ventricular-Assist device infections. In: Clinical Infectious Diseases. 2010 ; Vol. 50, No. 5. pp. 664-671.
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abstract = "Background. Infection is a common complication of ventricular-assist devices (VADs) and is associated with rehospitalization, thromboembolic events, VAD malfunction, delay in heart transplantation, and a high mortalityrate. The objectives of this study were to investigate the frequency of fungal VAD infections and assess various risk factors and their effects on mortality as compared with bacterial VAD infections. Methods. We conducted a retrospective chart review of patients with infected VADs at a single tertiary care center. The frequency, risk factors, and outcomes of fungal versus bacterial VAD infections were compared. Results. Of the 300 patients who received a VAD, 108 (36{\%}) developed VAD infection, including 85 bacterial and 23 fungal infections. Most common bacterial causes of infection were Staphylococcus aureus, coagulase-negative staphylococci, enterococci, and Pseudomonas aeuruginosa. The most common fungal etiologic agent was Candida albicans. Only the use of total parenteral nutrition was associated with the development of a fungal VAD infection in multivariate analysis (odds ratio, 6.95; 95{\%} confidence interval, 1.71-28.16; P = .007). Patients who experienced fungal VAD infection were less likely to be cured (17.4{\%} vs 56.3{\%}; P = .001) and had greater mortality (91{\%} vs 61{\%}; P = .006), compared with those who experienced bacterial VAD infection. Conclusions. Fungi were responsible for approximately one-fifth of VAD infections and were associated with a mortality rate of 91{\%}. Restriction of total parenteral nutrition use is essential in decreasing the rate of fungal VAD infection. Trials are needed for investigating the use of echinocandins or lipid formulations of amphotericin B for prevention and/or treatment of fungal VAD infection.",
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