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首页> 外文期刊>Artificial Organs >Clinical outcomes associated with chronic antimicrobial suppression therapy in patients with continuous-flow left ventricular assist devices
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Clinical outcomes associated with chronic antimicrobial suppression therapy in patients with continuous-flow left ventricular assist devices

机译：连续流式左心室辅助设备患者与慢性抑菌治疗相关的临床结果

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摘要

This retrospective cohort study evaluates the effect of chronic antimicrobial suppression (CAS) therapy on clinical outcomes in patients with continuous-flow left ventricular assist devices (CF-LVADs) and a history of device-related infection. Patients with CF-LVAD implantation between January 2008 and August 2011 who received systemic CAS after index antibiotic treatment of a device-related infection were included. Chronic suppression was defined as continuation of antibiotics for longer than 6 weeks after the index infection. Standard International Society for Heart and Lung Transplantation definitions were used. The primary outcome is failure of CAS, defined as a clinical deterioration resulting in the need for transition from oral to intravenous (IV) therapy or a need to change to a different IV antibiotic, elevation to status 1A on the transplant list as a result of ongoing infection, or device/driveline exchange. Of 140 patients screened, 16 patients were included (69% male, 63% African American, median age 52 years). The driveline was the most common site of infection (69%). Organisms isolated included Gram-positive cocci (n=7), Gram-negative bacilli (n=10), and Candida (n=1). Oral trimethoprim/sulfamethoxazole treatment was most commonly used for suppression (37.5%). Failure of CAS occurred in 5/16 (31%) patients after a mean time of 175 days on therapy (range 10-598). The majority of failures (60%) required device exchanges. Side effects of nausea, vomiting, or diarrhea were reported in three patients; all required changes in oral suppression regimen. Clostridium difficile infection was noted in two patients. These results, which must be confirmed by a larger analysis, suggest that one-third of CF-LVAD patients may develop recurrent infections while on CAS therapy.
机译：这项回顾性队列研究评估了慢性抗菌抑制（CAS）治疗对连续流左心室辅助装置（CF-LVADs）患者的临床结局以及装置相关感染史的影响。纳入2008年1月至2011年8月之间CF-LVAD植入的患者，这些患者在对与设备相关的感染进行了抗生素治疗后接受了全身CAS。慢性抑制被定义为指数感染后抗生素持续超过6周。使用标准的国际心脏和肺移植学会定义。主要结果是CAS衰竭，CAS定义为临床恶化，导致需要从口服转为静脉（IV）疗法或需要更换为不同的IV抗生素，由于持续感染，或设备/传动系统更换。在接受筛查的140例患者中，包括16例患者（男性69％，非裔美国人63％，中位年龄52岁）。传动系是最常见的感染部位（69％）。分离出的生物包括革兰氏阳性球菌（n = 7），革兰氏阴性杆菌（n = 10）和念珠菌（n = 1）。口服甲氧苄氨嘧啶/磺胺甲基异恶唑治疗最常用于抑制（37.5％）。平均175天的治疗时间（范围10-598）后，有5/16（31％）患者发生CAS失败。大多数故障（60％）需要更换设备。据报道三名患者有恶心，呕吐或腹泻的副作用。所有需要改变的口服抑制方案。在两名患者中发现了艰难梭菌感染。这些结果必须通过更大的分析予以证实，表明三分之一的CF-LVAD患者在接受CAS治疗时可能会反复感染。

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