Epidemiology and impact of device-specific infections on patients receiving left ventricular assist devices
Background: Left ventricular assist device-specific infections (LSIs) remain a persistent problem facing patients with durable left-ventricular assist devices (LVADs). However, the infectious agents and associated morbidity remained poorly defined. We sought to evaluate the incidence, epidemiology,...
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Elsevier
2025-05-01
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| author | Amit Iyengar, MD MSE Jason Feinman, MD Joyce Jiang, BS Cindy Song, BA Spencer Kim, BA Alvin Mathew, MD Sophia Golec, MD Aarti Rao, MD Ankitha Radakrishnan, MD Michaela Asher, MPhil David Rekhtman, BS John DePaolo, MD PhD Noah Moss, MD Shinobu Itagaki, MD Anelechi Anyanwu, MD Joyce Wald, DO Marisa Cevasco, MD MPH Aditya Parikh, MD |
| author_facet | Amit Iyengar, MD MSE Jason Feinman, MD Joyce Jiang, BS Cindy Song, BA Spencer Kim, BA Alvin Mathew, MD Sophia Golec, MD Aarti Rao, MD Ankitha Radakrishnan, MD Michaela Asher, MPhil David Rekhtman, BS John DePaolo, MD PhD Noah Moss, MD Shinobu Itagaki, MD Anelechi Anyanwu, MD Joyce Wald, DO Marisa Cevasco, MD MPH Aditya Parikh, MD |
| author_sort | Amit Iyengar, MD MSE |
| collection | DOAJ |
| description | Background: Left ventricular assist device-specific infections (LSIs) remain a persistent problem facing patients with durable left-ventricular assist devices (LVADs). However, the infectious agents and associated morbidity remained poorly defined. We sought to evaluate the incidence, epidemiology, and morbidity associated with LSIs in patients receiving modern centrifugal LVADs at 2 tertiary care centers. Methods: Retrospective analysis was performed of adult patients receiving HeartMate 3 implants at the University of Pennsylvania and Mount Sinai Health Systems from January 1, 2015 to March 31, 2021, with follow-up until March 31, 2022. Patients were grouped by history of LSI, defined as culture-positive infections and/or those requiring medical or surgical intervention. Demographic data, available culture data, medical interventions, and surgical interventions were queried. Survival analysis was censored at 4 years and landmarked according to 25th percentile time-to-infection. Results: Among 206 LVAD recipients, 71 (34.5%) developed an LSI. Predominant organisms were Staphylococcus (47.9%), Pseudomonas (15.5%), and Serratia (8.5%). Predictors of infection included Black race (LSI vs No LSI: 46.2% vs 29.2%, p=0.021) and body mass index (median 29.7 vs 26.2 kg/m2, p=0.007). Median time to infection was 231 days (112−423), with 19 (26.8%) patients requiring surgical debridement. Landmarked survival did not differ (log-rank p=0.830). LSI patients were hospitalized an extra 8 (0−28) days for infection-related reasons. Conclusion: LSIs remain pervasive, with most related to Staphylococcus, Pseudomonas, and Serratia, and are associated with significantly increased rehospitalization burden. Surgical interventions were utilized in 26.8% of patients. Continued efforts to understand and prevent LSIs are necessary to improve care for LVAD patients. |
| format | Article |
| id | doaj-art-7804725d038f4e41af54d0a572a5ad2c |
| institution | Kabale University |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
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| series | JHLT Open |
| spelling | doaj-art-7804725d038f4e41af54d0a572a5ad2c2025-02-06T05:13:08ZengElsevierJHLT Open2950-13342025-05-018100208Epidemiology and impact of device-specific infections on patients receiving left ventricular assist devicesAmit Iyengar, MD MSE0Jason Feinman, MD1Joyce Jiang, BS2Cindy Song, BA3Spencer Kim, BA4Alvin Mathew, MD5Sophia Golec, MD6Aarti Rao, MD7Ankitha Radakrishnan, MD8Michaela Asher, MPhil9David Rekhtman, BS10John DePaolo, MD PhD11Noah Moss, MD12Shinobu Itagaki, MD13Anelechi Anyanwu, MD14Joyce Wald, DO15Marisa Cevasco, MD MPH16Aditya Parikh, MD17Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PennsylvaniaDivision of Cardiovascular Medicine, Mount Sinai Health Systems, New York, New YorkPerelman School of Medicine, University of Pennsylvania, Philadelphia, PennsylvaniaPerelman School of Medicine, University of Pennsylvania, Philadelphia, PennsylvaniaPerelman School of Medicine, University of Pennsylvania, Philadelphia, PennsylvaniaDivision of Cardiovascular Medicine, Mount Sinai Health Systems, New York, New YorkDivision of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PennsylvaniaDivision of Cardiovascular Medicine, Mount Sinai Health Systems, New York, New YorkDivision of Cardiovascular Medicine, Mount Sinai Health Systems, New York, New YorkPerelman School of Medicine, University of Pennsylvania, Philadelphia, PennsylvaniaPerelman School of Medicine, University of Pennsylvania, Philadelphia, PennsylvaniaDivision of General Surgery, Hospital of the University of Pennsylvania, Philadelphia, PennsylvaniaDivision of Cardiovascular Medicine, Mount Sinai Health Systems, New York, New YorkDivision of Cardiovascular Surgery, Mount Sinai Health Systems, New York, New YorkDivision of Cardiovascular Surgery, Mount Sinai Health Systems, New York, New YorkDivision of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PennsylvaniaDivision of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PennsylvaniaDivision of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Corresponding author: Aditya Parikh, MD, Assistant Professor of Clinical Medicine, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, 2 East Pavilion, Philadelphia, PA.Background: Left ventricular assist device-specific infections (LSIs) remain a persistent problem facing patients with durable left-ventricular assist devices (LVADs). However, the infectious agents and associated morbidity remained poorly defined. We sought to evaluate the incidence, epidemiology, and morbidity associated with LSIs in patients receiving modern centrifugal LVADs at 2 tertiary care centers. Methods: Retrospective analysis was performed of adult patients receiving HeartMate 3 implants at the University of Pennsylvania and Mount Sinai Health Systems from January 1, 2015 to March 31, 2021, with follow-up until March 31, 2022. Patients were grouped by history of LSI, defined as culture-positive infections and/or those requiring medical or surgical intervention. Demographic data, available culture data, medical interventions, and surgical interventions were queried. Survival analysis was censored at 4 years and landmarked according to 25th percentile time-to-infection. Results: Among 206 LVAD recipients, 71 (34.5%) developed an LSI. Predominant organisms were Staphylococcus (47.9%), Pseudomonas (15.5%), and Serratia (8.5%). Predictors of infection included Black race (LSI vs No LSI: 46.2% vs 29.2%, p=0.021) and body mass index (median 29.7 vs 26.2 kg/m2, p=0.007). Median time to infection was 231 days (112−423), with 19 (26.8%) patients requiring surgical debridement. Landmarked survival did not differ (log-rank p=0.830). LSI patients were hospitalized an extra 8 (0−28) days for infection-related reasons. Conclusion: LSIs remain pervasive, with most related to Staphylococcus, Pseudomonas, and Serratia, and are associated with significantly increased rehospitalization burden. Surgical interventions were utilized in 26.8% of patients. Continued efforts to understand and prevent LSIs are necessary to improve care for LVAD patients.http://www.sciencedirect.com/science/article/pii/S2950133425000035left ventricular assist devicedriveline infectioninfectious diseaseepidemiologycardiac transplant |
| spellingShingle | Amit Iyengar, MD MSE Jason Feinman, MD Joyce Jiang, BS Cindy Song, BA Spencer Kim, BA Alvin Mathew, MD Sophia Golec, MD Aarti Rao, MD Ankitha Radakrishnan, MD Michaela Asher, MPhil David Rekhtman, BS John DePaolo, MD PhD Noah Moss, MD Shinobu Itagaki, MD Anelechi Anyanwu, MD Joyce Wald, DO Marisa Cevasco, MD MPH Aditya Parikh, MD Epidemiology and impact of device-specific infections on patients receiving left ventricular assist devices JHLT Open left ventricular assist device driveline infection infectious disease epidemiology cardiac transplant |
| title | Epidemiology and impact of device-specific infections on patients receiving left ventricular assist devices |
| title_full | Epidemiology and impact of device-specific infections on patients receiving left ventricular assist devices |
| title_fullStr | Epidemiology and impact of device-specific infections on patients receiving left ventricular assist devices |
| title_full_unstemmed | Epidemiology and impact of device-specific infections on patients receiving left ventricular assist devices |
| title_short | Epidemiology and impact of device-specific infections on patients receiving left ventricular assist devices |
| title_sort | epidemiology and impact of device specific infections on patients receiving left ventricular assist devices |
| topic | left ventricular assist device driveline infection infectious disease epidemiology cardiac transplant |
| url | http://www.sciencedirect.com/science/article/pii/S2950133425000035 |
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