Efficacy and safety of chronic antimicrobial suppression therapy for left ventricular assist device driveline infections: A single‐center descriptive experience

Radcliffe, Christopher; Doilicho, Natnael; Niu, Yu Si; Grant, Matthew

doi:10.1111/tid.13379

Cited by 13 publications

(9 citation statements)

References 22 publications

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“…Data supporting effectiveness of CAS has been conflicting, with wide range of reported relapses. 26–30 The majority (65.5%) of our DLI patients were placed on CAS. Notably, >40% of CAS patients required escalation to either IV antibiotics or I&D, thus proving this approach not uniformly successful.…”

Section: Discussionmentioning

confidence: 99%

Driveline Infection in Left Ventricular Assist Device Patients: Effect of Standardized Protocols, Pathogen Type, and Treatment Strategy

et al. 2022

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Driveline infection (DLI) is common after left ventricular assist device (LVAD). Limited data exist on DLI prevention and management. We investigated the impact of standardized driveline care initiatives, specific pathogens, and chronic antibiotic suppression (CAS) on DLI outcomes. 591 LVAD patients were retrospectively categorized based on driveline care initiatives implemented at our institution (2009-2019). Era (E)1: nonstandardized care; E2: standardized driveline care protocol; E3: addition of marking driveline exit site; E4: addition of "no shower" policy. 87(15%) patients developed DLI at a median (IQR) of 403(520) days. S. aureus and P. aeruginosa were the most common pathogens. 31 (36%) of DLI patients required incision and drainage (I&D) and 5 (5.7%) device exchange. P. aeruginosa significantly increased risk for initial I&D (HR 2.7, 95% CI, 1.1-6.3) and recurrent I&D or death (HR 4.2, 95% CI, 1.4-12.5). Initial I&D was associated with a significant increased risk of death (HR 2.92 (1.33-6.44); P = 0.008) when compared to patients who did not develop DLI. Implementation of standardized driveline care protocol (E2) was associated with increased 2-year freedom from DLI compared to nonstandardized care (HR 0.36, 95% CI, 0.2-0.6, P < 0.01). Additional preventive strategies (E3&E4) showed no further reduction in DLI rates. 57(65%) DLI patients received CAS, 44% of them required escalation to intravenous antibiotics and/or I&D. Presence of P. aeruginosa DLI markedly increased risk for I&D or death. Conditional survival of patients progressing to I&D is diminished. Standardized driveline care protocol was associated with a significant reduction in DLI, while additional preventive strategies require further testing.

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Section: Discussionmentioning

confidence: 99%

Driveline Infection in Left Ventricular Assist Device Patients: Effect of Standardized Protocols, Pathogen Type, and Treatment Strategy

et al. 2022

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“…In this topic evidence in the published literature is conflicting. Some studies show a relationship between certain patient characteristics, such as obesity, 17,18 young age at implantation 19 or longer hospital stay 20 when others do not describe any risk factors associated with an increased risk of infection 21 . A 2019 systematic review of 34 articles shows 23 individual risk factors identified, the majority from a single study (18/34), or event factors associated with both increased and reduced risk of infection such as high BMI 22 …”

Section: Discussionmentioning

confidence: 99%

Ten‐year retrospective cohort analysis of ventricular assist device infections

et al. 2022

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Background:The number of patients treated by ventricular assist devices (VAD) and the duration of VAD treatment is increasing. One of the main complications in terms of morbidity and mortality for VAD patients are microbial infections.With this study, we aimed to investigate the epidemiology and microbiological characteristics of infections occurring in a VAD population to identify modifiable factors. Methods:We retrospectively analyzed patient characteristics, treatments and outcomes of VAD-specific/related infections. All patients implanted in our institution with a continuous flow VAD between January 2009 and January 2019 were included. Risk factors for VAD infection were assessed using simple and multiple linear regressions. Results:Of the 104 patients screened, 99 were included in the analysis, the majority of which were men (78%). At implantation, the mean age was 56 years and the median time on VAD support was 541 days. The overall infection rate per year per patient was 1.4. Forty-seven patients (60%) suffered from VAD-specific/related infection. Half of all infection episodes occurred in the first 4 months but the proportion of VAD-specific/related infection was higher after the first 4 months (74% of all infection). Using regression models, no patient specific risk factors were associated with VAD-specific/related infections. Conclusion:No predictive factors for infection during VAD support were identified in this study. By extension, diabetes, renal insufficiency, age or high BMI are not sufficient to deny a patient access to ventricular support.

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“…Transesophageal echocardiogram and CT are Data are listed as range between lowest and highest reported frequencies. 1,3,4,13,14,18,27,[31][32][33][34][35][40][41][42] DLI, driveline infection; PPI, pump pocket infection; BSI, blood stream infection; VAD, ventricular assist device.…”

Section: Routine Imagingmentioning

confidence: 99%

Infections in Patients With Left Ventricular Assist Devices: Current State and Future Perspectives

et al. 2023

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Mechanical circulatory support is increasingly being used as bridge-to-transplant and destination therapy in patients with advanced heart failure. Technologic improvements have led to increased patient survival and quality of life, but infection remains one of the leading adverse events following ventricular assist device (VAD) implantation. Infections can be classified as VAD-specific, VAD-related, and non-VAD infections. Risk of VAD-specific infections, such as driveline, pump pocket, and pump infections, remains for the duration of implantation. While adverse events are typically most common early (within 90 days of implantation), device-specific infection (primarily driveline) is a notable exception. No diminishment over time is seen, with event rates of 0.16 events per patient-year in both the early and late periods postimplantation. Management of VAD-specific infections requires aggressive treatment and chronic suppressive antimicrobial therapy is indicated when there is concern for seeding of the device. While surgical intervention/hardware removal is often necessary in prosthesis-related infections, this is not so easily accomplished with VADs. This review outlines the current state of infections in patients supported with VAD therapy and discusses future directions, including possibilities with fully implantable devices and novel approaches to treatment.

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Efficacy and safety of chronic antimicrobial suppression therapy for left ventricular assist device driveline infections: A single‐center descriptive experience

Cited by 13 publications

References 22 publications

Driveline Infection in Left Ventricular Assist Device Patients: Effect of Standardized Protocols, Pathogen Type, and Treatment Strategy

Driveline Infection in Left Ventricular Assist Device Patients: Effect of Standardized Protocols, Pathogen Type, and Treatment Strategy

Ten‐year retrospective cohort analysis of ventricular assist device infections

Infections in Patients With Left Ventricular Assist Devices: Current State and Future Perspectives

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