Colonization With Multiresistant Bacteria: Impact on Ventricular Assist Device Patients
Colonization With Multiresistant Bacteria: Impact on Ventricular Assist Device Patients
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DOI：
10.1016/j.athoracsur.2017.07.050
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发表时间：
2018-02-01
影响因子：
4.6
通讯作者：
Luedike, Peter
中科院分区：
文献类型：
--
作者：
Papathanasiou, Maria;Pohl, Julia;Luedike, Peter
背景资料：尽管左心室辅助装置（LVAD）接受者中多重耐药菌（MDRB）感染的影响已得到充分表征，但围手术期定植对该患者队列中感染发展的影响仍未知。该研究评估了MDRB定植对LVADimplantation.Methods后患者结局的影响：我们回顾性分析了2010年至2015年期间在我们中心接受LVAD的82例连续患者的鼻，喉，伤口和直肠拭子的微生物筛查研究。确定了四类MDRB：耐甲氧西林金黄色葡萄球菌、耐万古霉素肠球菌和对四种预定药理学类别抗生素中的三种或四种耐药的革兰氏阴性菌。我们还比较了长期的结果，患者和没有colonization.Results：有28例（34.1%）被诊断为被殖民与至少1种MDRB。MDRB定植与任何病原体致死性感染的发生相关（MDRB阳性，63.2%; MDRB阴性，34.4%; p = 0.04）和致死性MDRB特异性感染MDRB阳性31.6%，阴性6.3%; p = 0.04），重症监护室住院时间显著延长（p < 0.0001），累积住院时间更长结论：我们的研究表明，MDRB的定植是LVAD易感人群中感染相关死亡的一个高度流行的危险因素。应考虑在LVAD植入前后进行MDRB的常规筛查，以识别高风险个体并促进感染并发症的有效预防。(C)2018胸外科医师协会
Background: Although the effect of infections with multidrug-resistant bacteria (MDRB) in left ventricular assist device (LVAD) recipients is well characterized, the influence of perioperative colonization on the development of infections in this patient cohort remains unknown. The study evaluated the effect of MDRB colonization on patient outcomes after LVAD implantation.Methods: We retrospectively analyzed the microbiological screening studies of nasal, throat, wound, and rectal swabs in 82 consecutive patients who received an LVAD at our center between 2010 and 2015. Four categories of MDRB were determined: methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and Gram-negative bacterium resistant to three or four of four predefined pharmacologic categories of antibiotics. We also compared the long-term outcome of patients with and without colonization.Results: There were 28 patients (34.1%) diagnosed as being colonized with at least 1 species of an MDRB. MDRB colonization was associated with the occurrence of fatal infections from any pathogen (MDRB positive, 63.2%; MDRB negative, 34.4%; p = 0.04) and fatal MDRB-specific infections (MDRB positive, 31.6%; MDRB negative, 6.3%; p = 0.04), significantly longer intensive care unit stay (p < 0.0001), and longer cumulative hospital stay (p = 0.04).Conclusions: Our study demonstrates that the colonization with MDRB is a highly prevalent risk factor for infection-associated death in the vulnerable LVAD population. Routine screening for MDRB before and after LVAD implantation should be considered to identify high-risk individuals and facilitate effective prevention of infectious complications. (C) 2018 by The Society of Thoracic Surgeons