Abstract
For the purposes of this chapter, we will discuss the management of infections of devices used in solid organ transplant (SOT). Post transplantation, SOT recipients frequently require additional interventions including central venous access catheters (CVC) or, occasionally, temporary support with extracorporeal membrane oxygenation (ECMO) intervention. Infections in these devices will be addressed. Furthermore, we will review infections associated with ventricular assist devices (VAD) when used as bridges to heart transplant (HT). Infection remains a significant complication of LVAD implantation and is associated with inferior clinical prognosis. This is especially true in patients who develop more serious systemic infections, such as sepsis, where the mortality in the following 2 years can be greater than 50%. Furthermore, the development of multi-organ dysfunction (especially cardiac and renal) is also frequently seen as sequelae of infection and complicates morbidity and mortality considerably. The ongoing management of mechanical circulatory device (MCS) infections in patients who proceed to transplant will also be discussed in this chapter, as these patients suffer more frequent relapse associated with retained material from their infected device.
CVC, ECMO, and VAD infections all share features that create unique infection risk, in that they all contain a foreign material placed with a percutaneous exit site and an internal, intravascular component.
Signs and symptoms of systemic device-associated infection may be subdued in the SOT recipient. The differential for potential pathogens may be broader in the immunocompromised postoperative host, not only because of their immunosuppression but also because of their frequent hospital exposure. Furthermore, the HT who was bridged with an initially infected VAD has a potentially increased risk for multidrug-resistant (MDR) infections due to antibiotic exposures, though this has not been well studied or documented in the current literature. Diagnosis and management of these infections will be discussed.
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Wolfe, C.R., Mooney, M.L. (2019). Management of Infections of Devices: Catheter-Related Infections, Pretransplant VAD Infections, Infections of ECMO Devices. In: Manuel, O., Ison, M. (eds) Infectious Diseases in Solid-Organ Transplant Recipients. Springer, Cham. https://doi.org/10.1007/978-3-030-15394-6_19
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DOI: https://doi.org/10.1007/978-3-030-15394-6_19
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