Delayed febrile response with bloodstream infections in patients with continuous-flow left ventricular assist devices
Autor: | Christopher A. Wrobel, William K. Cornwell, Alpesh Amin, Jennifer T. Thibodeau, Robert M. Morlend, Colby Ayers, Justin L. Grodin, Sonia Garg, Faris G. Araj, Mark H. Drazner, David Pham, Pradeep P.A. Mammen, Ricardo M. La Hoz |
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Rok vydání: | 2018 |
Předmět: |
Inotrope
Adult Male medicine.medical_specialty Time Factors Fever Heart Ventricles 030204 cardiovascular system & hematology 030230 surgery General Biochemistry Genetics and Molecular Biology Article 03 medical and health sciences 0302 clinical medicine Internal medicine Sepsis Medicine Humans In patient Aged Retrospective Studies Heart Failure business.industry Continuous flow General Medicine Middle Aged medicine.disease equipment and supplies Disease control Pathophysiology Lower temperature Catheter Heart failure Cardiology Female Heart-Assist Devices business |
Zdroj: | Journal of investigative medicine : the official publication of the American Federation for Clinical Research. 67(3) |
ISSN: | 1708-8267 |
Popis: | Bloodstream infections (BSIs) are common in patients with continuous-flow left ventricular assist devices (CF-LVADs). Whether CF-LVADs modulate the febrile response to BSIs is unknown. We retrospectively compared the febrile response to BSIs in patients with heart failure (HF) with CF-LVADs versus a control population of patients with HF receiving inotropic infusions. BSIs were adjudicated using the Centers for Disease Control and Prevention and the National Healthcare Safety Network criteria. Febrile status (temperature ≥38°C, 100.4 °F), temperature at presentation with BSI, and the highest temperature within 72 hours (Tmax) were collected. We observed 59 BSIs in LVAD patients and 45 BSIs in controls. LVAD patients were more likely to be afebrile and to have a lower temperature at presentation than control (88% vs 58%, p=0.002, and 37°C ±0.7 vs 37.7°C ±1.0, p=0.0009, respectively). By 72 hours, the difference in afebrile status diminished (53% vs 44%, p=0.42), and the Tmax was similar between the LVAD and control groups (37.9°C±0.9 vs 38.2°C±0.8, respectively, p=0.10). In conclusion, at presentation with a BSI, the vast majority of CF-LVAD patients were afebrile, an event which occurred at a higher frequency when compared with patients with advanced HF on chronic inotropes via an indwelling venous catheter. These data alert clinicians to have a very low threshold to obtain blood cultures in CF-LVAD patients even in the absence of fever. Further study is needed to determine whether a delayed or diminished febrile response represents another pathophysiological consequence of CF-LVADs. |
Databáze: | OpenAIRE |
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