engleski

Microbiological monitoring and infection control in patients with mechanical cardiac support devices

Objectives Continuous-flow left ventricular assist devices (LVAD) are increasingly being used in patients with end- stage heart failure, but infection is a still frequent and one of the major complications associated with the use of device support. The objectives of this study were to investigate microbiological findings and consequences of infection in patients with VADs. Methods We conducted a retrospective chart review of patients with infected VADs at Dubrava University Hospital through 16 months four patients received mechanical circulatory support (one patient was implanted PVAD and the others LVAD) either as bridge to transplantation or as destination therapy. Results The first patient though the mechanical heart was removed by using intensive hemodynamic monitoring and applying carefully chosen, state-of-the-art antimicrobial therapy, died due to septic shock, as well as other patient, only two days following the operation, due to sepsis of unknown aetiology. The third patient was released from hospital soon after the operation with adequate and carefully chosen antimicrobial therapy based on the microbiological samples. The fourth patient, with both pre- and post-operative states being stable, ended the hospitalisation in December 2009 ; eight months following the VAD implantation, in June 2010, heart transplantation was successfully performed. Conclusion Timing of intervention, optimization of the preimplantation patient status, adherence to evidence-based infection control and prevention guidelines, meticulous surgical technique and optimal post-operative surgical site care form the foundation for VAD-associated infection prevention. Microbiological monitoring and prevention strategies, with medical and surgical management of infections may increase survival and decrease morbidity among LVAD patients.

left ventricular assist devices; LVAD; infection; pathogens; heart failure

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