Gallium-67 Single-Photon Emission Computed Tomography Affects Management of Infections of Left Ventricular Assist Devices
Gallium-67 Single-Photon Emission Computed Tomography Affects Management of Infections of Left Ventricular Assist Devices
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DOI：
10.1097/mat.0000000000001316
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发表时间：
2021-07-01
期刊：
影响因子：
4.2
通讯作者：
Moadel, Renee M.
中科院分区：
文献类型：
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作者：
Puius, Yoram A.;Parkar, Fauziya;Moadel, Renee M.
我们机构使用镓-67单光子发射计算机体层摄影低剂量CT(Ga-SPECT-CT)来确定左心室辅助装置(LVAD)感染的存在和程度。我们对2011年1月至2018年6月接受Ga-SPECT-CT的41名LVAD受者进行了一项单中心的回顾性研究，以确定Ga-SPECT-CT是否导致了抗菌治疗、LVAD修订或更换或1A例外申请的变化。平均年龄为56.6岁，主要为男性(80.5%)和糖尿病(68.3%)，分为缺血性心肌病(48.8%)和非缺血性心肌病(51.2%)。大多数人使用了HeartMate II设备(82.9%)。与设备相关的感染分为可能感染(12.2%)、可能感染(36.6%)、确诊感染(36.6%)或排斥感染(14.6%)。敏感性为68.6%，特异性为100%。VAD特异性感染多为经皮深部驱动(DRI)感染(34.1%)，VAD相关感染主要为血流感染(31.7%)。分离的主要病原菌为金黄色葡萄球菌。镓-67单光子发射计算机体层摄影低剂量CT导致超过一半(53.7%)患者的处理发生变化：开始(24.4%)或停止(17.1%)抗菌治疗，LVAD翻修(22.0%)或更换(12.2%)，申请1例例外移植(17.1%)。我们的结论是，Ga-SPECT-CT是一种有效的方式来确定LVAD DRIs的存在和范围，并在超过一半的病例中促成了管理的改变。
Our institution employs gallium-67 single-photon emission computed tomography low-dose CT (Ga-SPECT-CT) to determine the presence and extent of left ventricular assist device (LVAD) infections. We present a retrospective single-center study of 41 LVAD recipients who underwent Ga-SPECT-CT from January 2011 to June 2018 to determine whether Ga-SPECT-CT led to changes in antimicrobial therapy, LVAD revision or exchange, or application for 1A exception. The average age was 56.6 years, predominantly male (80.5%) and diabetic (68.3%), divided between ischemic (48.8%) and nonischemic (51.2%) cardiomyopathy. The majority had HeartMate II devices (82.9%). Device-related infections were classified as possible (12.2%), probable (36.6%), proven (36.6%), or rejected (14.6%). Sensitivity was 68.6% and specificity was 100%. Most VAD-specific infections were percutaneous deep driveline infections (DRIs) (34.1%), and VAD-related infections were primarily bloodstream infections (31.7%). Staphylococcus aureus was the major pathogen isolated. Gallium-67 single-photon emission computed tomography low-dose CT resulted in changes in management in more than half (53.7%) of patients: starting (24.4%) or stopping (17.1%) antimicrobial therapy, LVAD revision (22.0%) or exchange (12.2%), and the application for 1A exception for transplant listing (17.1%). We conclude that Ga-SPECT-CT is an effective modality for determining the presence and extent of LVAD DRIs, and contributed to a change in management in more than half of cases.