Anaerobic Bacteremias in Left Ventricular Assist Devices and Advanced Heart Failure

Table 1

Relevant clinical features of patients with anerobic bacteremias.

Clinical feature	Patient 1	Patient 2	Patient 3	Patient 4
Sex	Male	Male	Male	Male
Age	28	78	47	65
Comorbidities	pHTN, OSA, IDA, obesity	Dilated cardiomyopathy, HTN, Afib, T2DM, gout	Nonischemic cardiomyopathy	T2DM, current smoking
LVAD present	Yes	Yes	Yes	Yes
Driveline cultures	No	Yes (previously)	Yes (during second admission)	Yes
LVAD-related infection	No	Yes (history of)	Yes (as a complication)	Yes
Risk factors	Drug abuse, former smoker	Liable INR, several GI bleeding	Anticoagulation	Poor dentition LVAD infection
Isolated bacteria	Fusobacterium nucleatum	Bacteroides thetaiotaomicron/Citrobacter Freundii	Fusobacterium nucleatum	Parvimonas micra
Source	Lung (PNA)	PNA vs. transient GI translocation	PNA	Mouth
Outcome	Improvement	Severe septic shock	Cardiogenic shock and coagulopathy	LVAD thrombosis
Treatment	MTZ	MTZ	MTZ	MTZ
Recurrent bacteremia	No	Yes	Yes	Yes
GI bleeding	No	Yes	No	No
Mortality
30 days	No	No	No	No
90 days	No	No	Yes	No
1 year	No	Yes	Yes	N/A
Deceased	Yes	Yes	Yes	No
Cause of death	Septic shock due to S. aureus bacteremia	Septic shock due to Citrobacter freundii	LVAD thrombosis, Rhizopus pocket infection, and hemorrhagic stroke	N/A

Afib: atrial fibrillation, GI: gastrointestinal, HTN: hypertension, IDA: iron deficiency anemia, LVAD: left ventricular assisted device; MTZ: metronidazole, OSA: obstructive sleep apnea, pHTN: pulmonary hypertension, PNA: pneumonia, T2DM: type 2 diabetes mellitus.