Incidence of healthcare-associated infections in a pediatric population with extracorporeal ventricular assist device

  • Fragasso T
  • Grutter G
  • Ricci Z
 et al. 
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Abstract

Background: To evaluate Healthcare-Associated Infection (HAI) rates in pediatric patients supported by EXCOR Pediatric (Berlin Heart, BH) ventricular assist device (VAD). Setting: Pediatric Cardiosurgical Intensive Care Unit (pCICU). Methods: Retrospective analysis of all patients admitted to pCICU for VAD implantation between January 1, 2009 and December 31, 2010 (24 months). Diagnoses were made according to Center for Disease Control (CDC). Results: Nine patients' charts were reviewed. Median age was 8 months (6-11 IQR), seven patients had a Left VAD(LVAD), two a Bi-VAD. All patients with LVAD underwent heart transplant after a median of 59 days (37-109 IQR) of support. All patients with Bi-VAD (2) died after 12 days of assistance. No HAIs were recorded during their admission. Fifteen HAIs were reported in 5 patients out of 9 (56%). All infected patients had more than one HAI during their admission and, compared to non infected, a longer mechanical support (104 vs 32 days, P < 0.05) and a longer pCICU Length of Hospital Stay (LOHS, 129 vs 51 days P < 0.05). The table below summarizes microbiology. Four bacteria were multidrug resistant, 3 carbapenem-resistant P. aeruginosa (50% of of all Pseudomonas isolated) and 1 Methicillin-Resistant S. aureus (MRSA). One patient had an endocarditis on mechanical ventricle caused by P. aeruginosa the day of transplant (diagnosed intraoperatively by positive blood culture and swabs). He received appropriate antibiotic therapy perioperatively and no positive cultures in the postoperative period. Two patients with infection on insertion site of BH's cannulas had an uncomplicated post transplantation course. The third patient with infection on cannula's insertion site is still on VAD waiting for transplant. Conclusions: VAD use as a bridge to cardiac transplantation is associated with a large number of devicerelated infections. Patients with infected VADs wait longer for transplantation than patients with uninfected VADs with no impact on survival.

Author-supplied keywords

  • Germany
  • Pseudomonas
  • Pseudomonas aeruginosa
  • antibiotic therapy
  • assisted circulation
  • bacterium
  • biventricular assist device
  • blood culture
  • cannula
  • carbapenem
  • cardiopulmonary bypass
  • diagnosis
  • disease control
  • endocarditis
  • health care
  • heart
  • heart assist device
  • heart graft
  • heart transplantation
  • hospitalization
  • human
  • implantation
  • infection
  • infection rate
  • intensive care unit
  • left ventricular assist device
  • meticillin
  • microbiology
  • patient
  • population
  • postoperative period
  • survival
  • transplantation

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Authors

  • T Fragasso

  • G Grutter

  • Z Ricci

  • S Albanese

  • C Varano

  • A Amodeo

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