Task Force 4: Inpatient Management of Patients with MCSD - The ...

Infectious Issues
The classification of, investigations for, and definitions related to infection in
patients with MCS were the subject of a detailed working formulation published from the
Infectious Disease Council of the International Society of Heart and Lung
Transplantation in 2011. 87 A brief summary of their findings will be presented here as a
reference.
Infections in the setting of MCS can be classified as MCSD-specific, MCSDrelated,
or non-MCSD infections. For MCSD-specific infections, the source can be
related to the pump and/or cannula, the pump pocket, or the driveline. In contrast,
MCSD-related infections consist of infective endocarditis, blood stream infections, and
mediastinitis. Non-MCSD infections such as urinary tract infections will not be
addressed in these guidelines. When approaching a patient on MCS with a suspected
infection, the initial work-up should include a complete blood count, chest radiography,
and blood cultures. For those with purulent drainage from a surgical site, cannula, or
driveline, samples for Gram stain, KOH, and routine bacterial and fungal cultures should
be obtained.
Recommendations for MCS Patients with a Suspected Infection:
Class I:
1. In all patients, a complete blood count, chest radiography, and blood cultures is
recommended.
Level of Evidence: A.
2. At least three sets of blood cultures over 24 hours should be drawn, with at least one
from any indwelling central venous catheters.
Level of Evidence: A.
3. For those with a suspected cannula or driveline infection, obtaining a sample for
Gram stain, KOH, and routine bacterial and fungal cultures is recommended.
Level of Evidence: A.
4. When clinically indicated, aspirate from other potential sources as dictated by
presenting symptoms and examination is recommended.
Level of Evidence: A.
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