Outcome of Heart Transplantation After Pseudomonas Left Ventricular Assist Device Infection
1Infectious Disease, Cleveland Clinic, Cleveland, OH, 2Cleveland Clinic Foundation, Cleveland, OH, 3Cleveland Clinic, Cleveland, OH
Meeting: 2022 American Transplant Congress
Abstract number: 1141
Keywords: Bacterial infection, Heart transplant patients, Infection, Ventricular assist devices
Topic: Clinical Science » Heart » 63 - Heart and VADs: All Topics
Session Information
Session Time: 7:00pm-8:00pm
Presentation Time: 7:00pm-8:00pm
Location: Hynes Halls C & D
*Purpose: Pseudomonas aeruginosa (PA) is the most common gram-negative bacteria to cause left ventricular assist device (LVAD) infection. Management is difficult given limited oral antibiotic options and the presence of retained hardware. In this study, we examined the outcomes of patients who developed Pseudomonas aeruginosa LVAD infection (PA-LVADI) who subsequently received heart transplantation.
*Methods: We identified patients in our institution, older than 18 years who received an LVAD from 2011 to 2021 and followed by heart transplantation.
*Results: There were 14 patients who developed PA-LVADI then received a heart transplant. The median number of days from LVAD placement to the first isolation of PA was 451 (range 112 – 1431). All had superficial/deep driveline infection at the time of diagnosis. 3 of 14 (21%) developed PA bacteremia. 7 of 14 (50%) required surgical intervention for PA-LVADI, 6 (86%) for debridement of deep driveline infection, and 1 (14%) for mediastinitis. 10 (71.5%) received intravenous (median 50.5 days, range 5 to 277), 3 received oral and 1 received no anti-pseudomonal antibiotics prior to heart transplant. The median number of days from diagnosis of PA-LVADI to transplant was 432 (range 115 – 812). At the time of transplant, 10 of 14 (71%) still had evidence of LVADI: 8 (80%) had culture-positive PA infection, 4 with pump pocket infection, and 4 with driveline infection. 2 (20%) had infection other than PA. After the transplant, 11 (79%) received anti-pseudomonal antibiotics for at least 3 days (median 28 days, range 6 – 42). Of the 14, 1 had MDR PA as first isolate, 1 developed ciprofloxacin resistance. 13 of 14 were followed for at least 1 year after transplant. There were no post-transplant infections due to PA. All 14 patients survived. There were no episodes of rejection requiring treatment.
|
Age in years, median (range) |
58 (40 – 65) |
| Male sex, n (%) | 11 (79) |
| LVAD type, n (%) : HeartWare ; HeartMate 2 ; HeartMate 3 | 3(21) ; 6(43) ; 5(36) |
| Heart failure etiology, n (%) : Ischemic heart disease ; Non-ischemic heart disease | 6(43) ; 8(57) |
| Diabetes Mellitus, n (%) | 4 (29) |
| Hypertension, n (%) | 9 (64) |
| Chronic kidney disease, n (%) | 5 (36) |
| Cardiac Implantable Electronic Device, n (%) | 11 (79) |
*Conclusions: Management of PA-LVADI can be challenging and often necessitates surgical management and prolonged IV antibiotic use. However, our patients had excellent outcomes after transplantation without recurrence of infection, suggesting that transplant is curative for PA-LVADI. Further studies are needed to compare outcomes with those who had LVADI due to other organisms.
To cite this abstract in AMA style:
Murugan LThirunavukarasu, Koval C, Banzon J. Outcome of Heart Transplantation After Pseudomonas Left Ventricular Assist Device Infection [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/outcome-of-heart-transplantation-after-pseudomonas-left-ventricular-assist-device-infection/. Accessed November 21, 2024.« Back to 2022 American Transplant Congress