19.1 Evidence for preventing infection in preimplantation of mechanical circulatory support
Nosocomial bloodstream infection (BSI) has been reported as a major source of morbidity and mortality in patients with MCS [472]. In general the risk of infection associated with catheters depends on type, location and duration in situ [473]. A recent study from the International Society of Heart and Lung Transplantation IMACS Registry, to which the EUROMACS Registry contributes, showed that early-onset BSI was associated with a significantly increased 24-month mortality rate and that 85% of these BSIs were not device related. There is an opportunity for infection prevention practices to decrease the BSI event rate in the intensive care unit and post-surgical settings, which may affect the 24-month survival rate [474].
Catheter-associated urinary tract infection is the most common nosocomial infection and is preventable by limiting the number of days of catheterization. As with indwelling catheters, a general proactive approach in patients with MCS of changing or reducing the duration of the catheters where possible to reduce the risk of infection is recommended as per other intensive care unit and post-surgical patients [475].