Mechanical Circulatory Support Infections in Heart Transplant Candidates

Research output: Contribution to journalReview articlepeer-review

Abstract

Purpose of Review: The landscape of mechanical circulatory support (MCS) and associated infections is evolving in the era of the new United Network for Organ Sharing (UNOS) heart allocation system. Multidrug-resistant infections, atypical pathogens, and use of novel therapeutics in these patients need greater recognition. Recent Findings: The new UNOS heart allocation system has resulted in more patients bridged to transplant with temporary MCS and fewer transplants among patients with long-term MCS like left ventricular assist devices (LVAD) and corresponding shorter wait times for transplant. Newer LVADs with continuous-flow pumps are associated with lower rates of infection than earlier generation devices, but infection remains a major cause of morbidity and mortality. Multidrug-resistant organisms including methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa are common causes of VAD infection. The incidence of fungal infection is lower than with earlier devices, but there are challenges with emerging pathogens including nontuberculous mycobacteria. Nuclear medicine imaging may have a role for diagnosis of infection and determining the extent of involvement. Novel approaches to therapy include new antibiotics with expanded activity against multidrug-resistant organisms, bacteriophage therapy, and platelet-rich plasma and platelet gels. Summary: Infections associated with mechanical circulatory support are continuing to present new challenges related to the continued evolution of devices and recent changes in the UNOS heart allocation system. Practitioners should be aware of these changes as well as advances in novel diagnostics and therapeutics to aid with the management of refractory infections.

Original languageEnglish
JournalCurrent Infectious Disease Reports
Volume24
Issue number1
DOIs
StatePublished - Jan 2022

Keywords

  • Atypical pathogens
  • Bacteriophage therapy
  • Heart transplantation
  • LVAD
  • Multidrug resistance

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