ISHLT consensus statementWorking formulation for the standardization of definitions of infections in patients using ventricular assist devices
Section snippets
Scope
Providing a standard definition of infection in VAD recipients will permit analysis of the source, natural history, pathophysiology, and management of such infections. Thus, through internationally uniform data sets, we hope to gain insights that will lead to meaningful changes in practice to limit such infections.15 The proposed definitions are suitable for epidemiologic purposes but are also intended to assist clinicians in the clinical decision making process.
VAD-specific infections
VAD-specific infections may be of the hardware itself or the body surfaces that contain them and include infections of the pump, cannula, anastomoses, the pocket infections, and the percutaneous driveline or tunnel. Accurate VAD-specific infections required new definitions to be constructed to reflect the specifics of such infection to enable study of the potential sources or risk factors for these infections. Guidelines on the diagnosis of PJI,22 IE,16 cardiovascular device infections,20, 21
Non-VAD infections
Non-VAD infections are essentially “independent” or not directly related to the presence of the VAD but are infections occurring in a sick population of immunocompromised hosts with underlying comorbidities such as diabetes, prolonged hospitalization, multiple drug regimens, and renal impairment. The purpose of including non-VAD infection is to provide a comprehensive overview of all infections in this population and, in particular, to determine which international definition standards should
Discussion
Prevention and control of infection in patients using VADs will be most effectively accomplished if the risk factors for these infections are clearly known. Publications to date have used variable and heterogeneous definitions of VAD infection using various VAD devices, thereby limiting the comparison between the types and incidence of infection and the generalizability of this data across transplant centers.
These single-center studies have been small retrospective, record reviews using
Disclosure statement
Margaret Hannan received a grant from Pfizer; Shahid Husain received a grant from Pfizer, Astellas, and Merck; Ralph Corey is a Consultant and Medical Advisory Board Member for Achaogen, Astra-Zeneca, Cerexa, Cempra, Cubist, Furiex, Seachaid, Synerca, GSK, Tetraphase, Theravance, and The Medicine Co. and Medical Advisory Board Member for Merck, Pfizer, and Rib-x and received a research grant from Innocoil; Steve Gordon is a Medical Advisory Board Member for Thoratec; Niall Mahon received a
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