1859. Significance of Bacteremia in Left Ventricular Assist Device Infections due to Pseudomonas aeruginosa

Abstract Background Infection is one of the most common complications of Left Ventricular Assist Devices (LVADs). Pseudomonas aeruginosa (PsA) LVAD infections in particular are challenging due to limited antibiotic options and tendency to form biofilm making eradication difficult. In this study we examined the implications of bacteremia in patients with PsA LVAD infections. Methods This was a retrospective study of patients treated at our institution between July 1, 2007 and February 1, 2021 who had proven or probable driveline infection (DLI), pump pocket, or pump/cannula infection due to PsA according to International Society for Heart & Lung Transplantation criteria. Results Of 717 patients with an LVAD, 51 patients had had proven or probable VAD-specific infections due to PsA.16/51 (31%) had Pseudomonas bloodstream infection associated with the VAD infection, with a median 400 days from initial diagnosis. Only 29% of those with DLI were bacteremic, vs. 66% of those with pump pocket infection, and 50% of those with mediastinitis (Fig 1). Patients who developed bacteremia had a median of 3 episodes (range, 1-5). All but 1 patient with bacteremia received surgery. Of the 16 patients who developed bacteremia, 11 (69%) died vs 9/35 (26%) in patients who were not bacteremic (Fig 2). 10/11 patients who were bacteremic and died had infections limited to driveline. In 21/41 (51%) of episodes of bacteremia identified, patients were already on antibiotics for PsA with a median duration of 49 days (7-198) prior to onset of bacteremia. Conclusion A significant number of patients with PsA LVAD infections develop bacteremia, especially in those with involvement of central LVAD components. The presence of bacteremia should prompt evaluation for ascending infection. Most of the patients who developed bacteremia died, even when infection appeared limited to driveline, and it is possible that endoluminal infections were present in these cases. A substantial proportion of patients with bacteremia were on antibiotics at the time of bacteremia, which suggests that suppressive antibiotics alone may not be effective in controlling PsA LVAD infections. Disclosures All Authors: No reported disclosures.