Persistent Blood Stream Infection in Patients Supported With a Continuous-Flow Left Ventricular Assist Device Is Associated With an Increased Risk of Cerebrovascular Accidents

• We found that 30% of CF-LVAD patients developed bacteremia, and 19% of these had persistent BSI.
• Persistent BSI is associated with all-cause CVA and mortality in patients on CF-LVAD support.
• Persistent BSI is more associated with all-cause CVA in CF-LVAD patients than traditional risk factors such as age, atrial fibrillation, HTN.
• Pseudomonas aeruginosa BSI was an independent risk factor for CVA, particularly hemorrhagic CVA.
• Three of the seven patients with HCVA had a mycotic aneurysm demonstrated on cerebral angiography.

BackgroundCommon adverse events in patients supported with Continuous-flow left ventricular assist devices (CF-LVAD) include infections and cerebrovascular accidents (CVA). Some studies have suggested a possible association between blood stream infection (BSI) and CVA.Methods and ResultsMedical records of patients who received Heartmate II (HMII) CF-LVADs in 2008–2012 at a single center were reviewed. CVA was categorized as either hemorrhagic (HCVA) or ischemic (ICVA). BSI was divided into persistent (pBSI) and nonpersistent (non-pBSI). pBSI was defined as BSI with the same organism on repeated blood culture >72 hours from initial blood culture despite antibiotics. Univariate and multivariate analyses were performed to determine predictors. A total of 149 patients had HMII implanted; 76% were male, and the overall mean age was 55.4 ± 13 years. There were a total of 19 (13%) patients who had CVA (7 HCVA and 12 ICVA) at a median of 295 days (range 5–1,096 days) after implantation. There were a total of 28 (19%) patients with pBSI and 17 (11%) patients with non-pBSI. Patients with pBSI had a trend toward greater BMI (31 kg/m2 vs 27 kg/m2; P = .09), and longer duration of support (1,019 d vs 371 d; P < .001) compared with those with non-pBSI. Persistent BSI was associated with an increased risk of mortality and with all-cause CVA on multivariate analysis (odds ratio [OR] 5.97; P = .003) as well as persistent Pseudomonas aeruginosa infection (OR 4.54; P = .048).ConclusionsPersistent BSI is not uncommon in patients supported by CF-LVAD and is highly associated with all-cause CVA and increased all-cause mortality.

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