Cargando…

948. Ventricular Assist Device Infection due to Non-tuberculous Mycobacteria Leading to Successful Heart Transplantation: A Case Report and Literature Review

BACKGROUND: A 59-year-old man with acute myelogenous leukemia and matched allogeneic hematopoietic stem-cell transplant and non-ischemic cardiomyopathy requiring a left ventricular assist device (LVAD; HeartMate II™) was admitted after the spontaneous rupture of an abdominal fistula in his lower abd...

Descripción completa

Detalles Bibliográficos
Autores principales: Saldana, Carlos s, Rehm, Susan J, Koval, Christine E, Unai, Shinya, Tong, Zhen-Yu (Michael)
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8644771/
http://dx.doi.org/10.1093/ofid/ofab466.1143
_version_ 1784610163229982720
author Saldana, Carlos s
Rehm, Susan J
Rehm, Susan J
Koval, Christine E
Unai, Shinya
Tong, Zhen-Yu (Michael)
author_facet Saldana, Carlos s
Rehm, Susan J
Rehm, Susan J
Koval, Christine E
Unai, Shinya
Tong, Zhen-Yu (Michael)
author_sort Saldana, Carlos s
collection PubMed
description BACKGROUND: A 59-year-old man with acute myelogenous leukemia and matched allogeneic hematopoietic stem-cell transplant and non-ischemic cardiomyopathy requiring a left ventricular assist device (LVAD; HeartMate II™) was admitted after the spontaneous rupture of an abdominal fistula in his lower abdomen, and cloudy discharge from the driveline (DL) exit site for months. Figure 1 Denied systemic symptoms but had leukocytosis. CT scan of the abdomen revealed soft tissue enhancement around the LVAD DL Figure 2. Cultures from DL discharge grew Mycobacterium chelonae. He underwent incision and drainage (I&D) of the abdominal fistula, with unroofing of the tissue over the DL. Antimicrobial course is summarized in Table. He was thought to be an appropriate heart transplant candidate one month later. Cultures from the LVAD sites were negative. He completed antimicrobials for 10 weeks after transplant. 32 months after heart transplant he has no signs of M. chelonae infection. [Image: see text] Figure 1. Driveline exit site with scant cloudy discharge and a shallow 3 x 2-centimeter open lesion inferior to the umbilicus. Driveline track in dotted line. [Image: see text] Figure 2. CT scan of the abdomen revealed soft tissue enhancement (red arrows) around the LVAD driveline in the lower abdomen. METHODS: We performed a literature review of all published cases involving Non-Tuberculous Mycobacteria (NTM) and LVADs. Collected: date, sex and age, onset, organism, type of LVAD, transplant, surgical debridement, antimicrobials, outcome. RESULTS: A total of 11 patients with LVAD infection due to NTM have been described in the literature. Four cases of NTM LVAD infection culminated in heart transplantation. Cases are summarized in Table 1. All transplanted cases had an indolent presentation and driveline discharge, without systemic symptoms. All underwent I&D and/or de-roofing of the driveline and were treated with at least two active antimicrobials for an extended course ranging from 4 months and up to 17 months after transplant. All cases did well from the infection standpoint. One died within 12 months from transplant rejection. [Image: see text] CONCLUSION: Treatment with a combination with at least two active agents is recommended and continued for many months. Effective surgical debridement of affected tissue and unroofing of the driveline beyond the affected velour, along with the removal of the infected device at the time of cardiac transplant, is key to success. DISCLOSURES: Susan J. Rehm, MD, Lilly (Individual(s) Involved: Self): Shareholder; Merck (Individual(s) Involved: Self): Shareholder; Pfizer (Individual(s) Involved: Self): Shareholder
format Online
Article
Text
id pubmed-8644771
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-86447712021-12-06 948. Ventricular Assist Device Infection due to Non-tuberculous Mycobacteria Leading to Successful Heart Transplantation: A Case Report and Literature Review Saldana, Carlos s Rehm, Susan J Rehm, Susan J Koval, Christine E Unai, Shinya Tong, Zhen-Yu (Michael) Open Forum Infect Dis Poster Abstracts BACKGROUND: A 59-year-old man with acute myelogenous leukemia and matched allogeneic hematopoietic stem-cell transplant and non-ischemic cardiomyopathy requiring a left ventricular assist device (LVAD; HeartMate II™) was admitted after the spontaneous rupture of an abdominal fistula in his lower abdomen, and cloudy discharge from the driveline (DL) exit site for months. Figure 1 Denied systemic symptoms but had leukocytosis. CT scan of the abdomen revealed soft tissue enhancement around the LVAD DL Figure 2. Cultures from DL discharge grew Mycobacterium chelonae. He underwent incision and drainage (I&D) of the abdominal fistula, with unroofing of the tissue over the DL. Antimicrobial course is summarized in Table. He was thought to be an appropriate heart transplant candidate one month later. Cultures from the LVAD sites were negative. He completed antimicrobials for 10 weeks after transplant. 32 months after heart transplant he has no signs of M. chelonae infection. [Image: see text] Figure 1. Driveline exit site with scant cloudy discharge and a shallow 3 x 2-centimeter open lesion inferior to the umbilicus. Driveline track in dotted line. [Image: see text] Figure 2. CT scan of the abdomen revealed soft tissue enhancement (red arrows) around the LVAD driveline in the lower abdomen. METHODS: We performed a literature review of all published cases involving Non-Tuberculous Mycobacteria (NTM) and LVADs. Collected: date, sex and age, onset, organism, type of LVAD, transplant, surgical debridement, antimicrobials, outcome. RESULTS: A total of 11 patients with LVAD infection due to NTM have been described in the literature. Four cases of NTM LVAD infection culminated in heart transplantation. Cases are summarized in Table 1. All transplanted cases had an indolent presentation and driveline discharge, without systemic symptoms. All underwent I&D and/or de-roofing of the driveline and were treated with at least two active antimicrobials for an extended course ranging from 4 months and up to 17 months after transplant. All cases did well from the infection standpoint. One died within 12 months from transplant rejection. [Image: see text] CONCLUSION: Treatment with a combination with at least two active agents is recommended and continued for many months. Effective surgical debridement of affected tissue and unroofing of the driveline beyond the affected velour, along with the removal of the infected device at the time of cardiac transplant, is key to success. DISCLOSURES: Susan J. Rehm, MD, Lilly (Individual(s) Involved: Self): Shareholder; Merck (Individual(s) Involved: Self): Shareholder; Pfizer (Individual(s) Involved: Self): Shareholder Oxford University Press 2021-12-04 /pmc/articles/PMC8644771/ http://dx.doi.org/10.1093/ofid/ofab466.1143 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Poster Abstracts
Saldana, Carlos s
Rehm, Susan J
Rehm, Susan J
Koval, Christine E
Unai, Shinya
Tong, Zhen-Yu (Michael)
948. Ventricular Assist Device Infection due to Non-tuberculous Mycobacteria Leading to Successful Heart Transplantation: A Case Report and Literature Review
title 948. Ventricular Assist Device Infection due to Non-tuberculous Mycobacteria Leading to Successful Heart Transplantation: A Case Report and Literature Review
title_full 948. Ventricular Assist Device Infection due to Non-tuberculous Mycobacteria Leading to Successful Heart Transplantation: A Case Report and Literature Review
title_fullStr 948. Ventricular Assist Device Infection due to Non-tuberculous Mycobacteria Leading to Successful Heart Transplantation: A Case Report and Literature Review
title_full_unstemmed 948. Ventricular Assist Device Infection due to Non-tuberculous Mycobacteria Leading to Successful Heart Transplantation: A Case Report and Literature Review
title_short 948. Ventricular Assist Device Infection due to Non-tuberculous Mycobacteria Leading to Successful Heart Transplantation: A Case Report and Literature Review
title_sort 948. ventricular assist device infection due to non-tuberculous mycobacteria leading to successful heart transplantation: a case report and literature review
topic Poster Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8644771/
http://dx.doi.org/10.1093/ofid/ofab466.1143
work_keys_str_mv AT saldanacarloss 948ventricularassistdeviceinfectionduetonontuberculousmycobacterialeadingtosuccessfulhearttransplantationacasereportandliteraturereview
AT rehmsusanj 948ventricularassistdeviceinfectionduetonontuberculousmycobacterialeadingtosuccessfulhearttransplantationacasereportandliteraturereview
AT rehmsusanj 948ventricularassistdeviceinfectionduetonontuberculousmycobacterialeadingtosuccessfulhearttransplantationacasereportandliteraturereview
AT kovalchristinee 948ventricularassistdeviceinfectionduetonontuberculousmycobacterialeadingtosuccessfulhearttransplantationacasereportandliteraturereview
AT unaishinya 948ventricularassistdeviceinfectionduetonontuberculousmycobacterialeadingtosuccessfulhearttransplantationacasereportandliteraturereview
AT tongzhenyumichael 948ventricularassistdeviceinfectionduetonontuberculousmycobacterialeadingtosuccessfulhearttransplantationacasereportandliteraturereview