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Published on: July 20, 2022
Infections in children with left ventricular assist device
Semra Şen1, Zülal Ülger2, Zümrüt Şahbudak Bal1
1Department of Pediatric Infectious Disease, Ege University Hospital, Izmir, Turkey.
Insights
Pediatric left ventricular assist device (VAD) infections are common, with Gram-positive bacteria being the most frequent cause. However, Gram-negative and fungal infections significantly increase mortality risk in VAD patients awaiting transplantation.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Medical Device Technology
Background:
- Limited data exists on pediatric left ventricular assist device (VAD) infections in developing nations.
- Investigating postimplantation infectious complications and their pathogens is crucial for VAD patient outcomes.
Purpose of the Study:
- To determine the incidence and characteristics of infectious complications in pediatric patients with left ventricular assist devices (VADs).
- To identify the pathogenic profile of these infections and their impact on patient outcomes, including mortality.
Main Methods:
- Retrospective analysis of patient charts from 27 pediatric patients with dilated cardiomyopathy who received a left VAD.
- Data collection focused on infection episodes, causative agents, hospitalization duration, ICU admissions, and mortality.
Main Results:
- 81.48% of patients experienced infections, with driveline exit site infections being most common.
- Gram-positive bacteria were the predominant pathogens, but Gram-negative and fungal infections were associated with increased mortality.
- Infected patients had significantly prolonged hospitalizations and higher ICU admission rates, particularly with fungal infections.
Conclusions:
- Ventricular assist device-related infections are frequent in pediatric populations, predominantly caused by Gram-positive bacteria.
- The rise of Gram-negative and fungal infections correlates with increased pre-transplant mortality.
- Implementing surveillance, infection control, and antibiotic stewardship programs is vital for reducing VAD patient mortality in developing countries.
Background:
There are limited data about pediatric left ventricular assist device (VAD) infections in developing countries. This study aimed to investigate device postimplantation infectious complications and their pathogenic profile.
Methods:
Data were analyzed from patient charts involving 27 patients with dilated cardiomyopathy who underwent left VAD implantation at a leading tertiary care center in Turkey.
Results:
The study included 17 boys and ten girls with a median age of 12.22 years (range 17 months to 18 years). Nineteen patients were diagnosed with idiopathic, and three were diagnosed with familial dilated cardiomyopathy. Twenty-two out of 27 subjects (%81.48) developed 80 infection episodes in total. The most common type of left VAD-specific infection was the exit site of the driveline. Infected patients with left VAD had a significantly prolonged hospitalization compared with the patients without infection (P = .014). Infection-induced pediatric intensive care unit (ICU) admission was higher in patients with fungal infection(P = .023). Gram-positive staphylococci were the most commonly isolated bacterial pathogens, followed by Gram-negative bacteria. Five patients developed fungal infections. None of the fungal infection patients underwent transplantation(P = .035). Seven deaths occurred in our study group. All deaths were in the infected group. Mortality was associated with the presence of multidrug-resistant Gram-negative bacterial infections (P = .015), an increased number of infection episodes (P = .003), and hospitalization due to infection (P = .003).
Conclusion:
Ventricular assist device-related infections were frequent among our study patients. The predominantly isolated agents were Gram-positive bacterial pathogens. However, the emergence of relatively high rate of Gram-negative bacterial and fungal infections was associated with mortality before the transplantation. Establishing local programs for surveillance data, controlling for infection rates, and antibiotic stewardship are essential to reduce mortality of VAD patients in developing countries.
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