Circulation：新型心室辅助装置未能降低感染发生率

　　美国学者的一项研究表明，感染为心室辅助装置（VAD）置入的常见并发症，并且新型的较小的装置未能减少感染发生；抑郁和肾功能不全有可能升高VAD感染风险。论文于2013年1月11日在线发表于《循环》（Circulation）。

　　此项多中心研究共纳入150例计划行VAD置入的患者，并前瞻性随访至心脏移植、因痊愈取出VAD、患者死亡或置入后1年。57%的患者植入Heartmate II装置。采集术前、术中和术后感染危险因素资料。收集可疑感染的临床、实验室和微生物学资料，并由感染专科医师加以评估。

　　结果显示，随访期间共有33例（22%）患者发生34起VAD相关性感染；发病率为0.01/100人-天。中位至感染时间为68天。传动轴为最常见感染部位，其中64%与侵袭性疾病相关。葡萄球菌为最常见病原菌（47%），但假单胞菌和其他革兰氏阴性菌亦造成32%的感染。抑郁病史和基线血清肌酐为VAD感染的独立预测因素。Heartmate II装置与感染风险降低无相关性。VAD感染可升高1年死亡率（P<0.0001）。

A Prospective, Multicenter Study of Ventricular Assist Device Infections

Background—Ventricular assist devices (VADs) improve survival and quality of life in patients with advanced heart failure, but their use is frequently complicated by infection. There are limited data on the microbiology and epidemiology of these infections.

Methods and Results—150 patients scheduled for VAD implantation were enrolled (2006-2008) at 11 U.S. cardiac centers and followed prospectively up to transplantation, explantation for recovery, death, or for one year. 86 (57%) patients received Heartmate II® devices. Data were collected on potential pre-, intra-, and post-operative risk factors for infection. Clinical, laboratory, and microbiologic data were collected for suspected infections and evaluated by an infectious diseases specialist. 33 (22%) subjects developed 34 VAD-related infections with an incidence rate of 0.01 per 100 person-days (95% CI, 0.073-0.142). The median time to infection was 68 days. The driveline was the most commonly infected site (n=28); 18 (64%) were associated with invasive disease. Staphylococci were the most common pathogen (47%), but Pseudomonas or other Gram-negative bacteria caused 32% of infections. A history of depression and elevated baseline serum creatinine were independent predictors of VAD infection (HR_adj=2.8,P=0.007 and HR_adj=1.7,P=0.023, respectively). The Heartmate II® was not associated with a decreased risk of infection. VAD infection increased one-year mortality (HR_adj=5.6, P<0.0001).

Conclusions—This prospective, multicenter study demonstrates that infection frequently complicates VAD placement and is a continuing problem despite the use of newer, smaller devices. Depression and renal dysfunction may increase the risk of VAD infection. VAD infection is a serious consequence as it adversely affects patient survival.