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New Horizons for the ID Council with IMACS

Margaret M Hannan, MD
Mater Hospital
Dublin, Ireland

margaret hannanIn April 2011 the ISHLT agreed to fund a new International Mechanically Assisted Circulatory Support (IMACS) registry (committee leadership) with a major emphasis on quality data collection that will build on the experiences gained from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). INTERMACS was created in 2006 to develop, manage and guide scientific investigations from a registry dedicated to durable MCS devices. At the time, there was less focus on infection and more focus on surgical parameters. INTERMACS was funded by the National Heart, Lung and Blood Institute (NHLBI) and was contracted to a group of investigators within ISHLT. This database has grown to more than 4,000 devices implanted since 2006.

With the ISHLT commitment on nurturing a multidisciplinary approach to improve the care of patients with MCS devices, the ID council of ISHLT has recently been invited to collaborate with the IMACS committee to create infection variables for the new IMACS database. This is an exciting new collaboration for the ID Council to be involved at the beginning of this major project with the selection of key variables, which will provide insightful data on an international platform of VAD infection in the future.

From an infectious disease perspective, the major limitations to data collected in the INTERMACS registry was the absence of data on causative organisms. The INTERMACS registry also could not discriminate between recurrent infection and new infection or provide details regarding the surgical management of such infections. As a consequence, some of the published studies have not been able to directly link percutaneous driveline infection (PDI) with septic death and morbidity. This information will be collected by all centers enrolled in the new IMACS registry and will provide an opportunity for international ID authors to collaborate in IMACS data analysis for future studies. In addition, the incorporation of ISHLT standardized definitions of infection into IMACS will allow better characterization of these infection events and will provide detailed epidemiological analysis in the future.

In particular, the new IMACS database will involve all international VAD programs large and small and will capture not only types of infection but also specific organisms, antibiotic prophylaxis, recurrent infection, surgical management and antibiotic treatment of infection. The standardized infection data captured in IMACS will allow meaningful statistical analysis on prospectively collected VAD-specific infection, VAD-related infection and non VAD-related infection. This type of standardized, well collected infection data embedded within a detailed international surgical network is an exciting project for the future but will depend on the quality of data entry world-wide. These prospective studies will focus primarily on bloodstream infections and surgical site infection (SSI) in the setting of VAD implant surgery, and the analysis will inform future SSI preventive strategies for VAD implant surgery and patient management. Further collaborative clinical trials, translational research, and interventional studies will be fostered in the areas of VAD infection as the IMACS registry grows and develops and will contribute greatly to the understanding of the pathogenesis of these complex and life-threatening infections over time.

Preventing these infections is a major paradigm for surgeons, cardiologists, and infectious diseases experts as our VAD patients live longer and more independent lives with these highly sophisticated devices. A challenge for the ID council now will be to develop and maintain good quality data collection of these new ID variables through not just the ISHLT network but through other internationally established ID platforms and VAD co-ordinator networks across the world under the steerage of the IMACS committee.

Disclosure Statement: The author has no conflicts of interest with the topic of this communication/article.