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Delayed febrile response with bloodstream infections in patients with continuous-flow left ventricular assist devices
  1. Christopher A Wrobel1,
  2. Mark H Drazner2,
  3. Colby R Ayers2,
  4. David D Pham2,
  5. Ricardo M La Hoz3,
  6. Justin L Grodin2,
  7. Sonia Garg2,
  8. Pradeep P A Mammen2,
  9. Robert M Morlend2,
  10. Faris Araj2,
  11. Alpesh A Amin2,
  12. William K Cornwell III2,
  13. Jennifer T Thibodeau2
  1. 1Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
  2. 2Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
  3. 3Department of Internal Medicine, Division of Infectious Disease, University of Texas Southwestern Medical Center, Dallas, Texas, USA
  1. Correspondence to Dr Jennifer T Thibodeau, Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas Texas 75390-9047, USA; jennifer.thibodeau{at}


Bloodstream infections (BSIs) are common in patients with continuous-flow left ventricular assist devices (CF-LVADs). Whether CF-LVADs modulate the febrile response to BSIs is unknown. We retrospectively compared the febrile response to BSIs in patients with heart failure (HF) with CF-LVADs versus a control population of patients with HF receiving inotropic infusions. BSIs were adjudicated using the Centers for Disease Control and Prevention and the National Healthcare Safety Network criteria. Febrile status (temperature ≥38°C, 100.4 °F), temperature at presentation with BSI, and the highest temperature within 72 hours (Tmax) were collected. We observed 59 BSIs in LVAD patients and 45 BSIs in controls. LVAD patients were more likely to be afebrile and to have a lower temperature at presentation than control (88% vs 58%, p=0.002, and 37°C ±0.7 vs 37.7°C ±1.0, p=0.0009, respectively). By 72 hours, the difference in afebrile status diminished (53% vs 44%, p=0.42), and the Tmax was similar between the LVAD and control groups (37.9°C±0.9 vs 38.2°C±0.8, respectively, p=0.10). In conclusion, at presentation with a BSI, the vast majority of CF-LVAD patients were afebrile, an event which occurred at a higher frequency when compared with patients with advanced HF on chronic inotropes via an indwelling venous catheter. These data alert clinicians to have a very low threshold to obtain blood cultures in CF-LVAD patients even in the absence of fever. Further study is needed to determine whether a delayed or diminished febrile response represents another pathophysiological consequence of CF-LVADs.

  • Bacterial Infections
  • Heart Failure
  • Heart-assist Devices
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  • Contributors All authors have participated in this work and have reviewed and agree with the content of the article. The entire article has been written by the authors and they received no form of external sponsorship or honorarium. JT, CAW, MHD, RMLH, DDP, JLG, SG, PPAM, RMM, FA, AAA, and WKC were involved in the conception and design of the study and interpretation of data. CRA was involved in the interpretation of data. All authors were involved in the drafting or critical revision of the manuscript. All authors have given final approval of the submitted manuscript.

  • Funding MHD acknowledges support from the James M Wooten Chair in Cardiology. WKC receives funding from an NIH/NHLBI mentored patient-oriented research career development award (1K23HL132048-01). RMLH receives support from the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001105. There are no relationships with industry.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study protocol was reviewed and approved by the University of Texas Southwestern Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement We do not have additional unpublished data to share.

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