Minimum inhibitory concentration changes in relapsed left ventricular assist device driveline infections

Abstract

Driveline infection is the most common infectious complication in patients with left ventricular assist devices. Minimum inhibitory concentration changes are not well described in relapsed driveline infections. This retrospective descriptive epidemiology study of patients with left ventricular assist device implantation between January 1, 2013, and August 1, 2017, who developed driveline infection with positive cultures aimed to describe minimum inhibitory concentration changes. Of the 330 patients underwent left ventricular assist device implantation, 30 (9%) met criteria for driveline infection. Median duration of follow-up was 26 months (interquartile range 16, 39) and time to first driveline infection was 171 days (interquartile range 83, 403). There were 74 driveline infections: 40 new and 34 relapsed. Staphylococcus aureus was most common in new and relapsed driveline infection. Thirteen patients comprised the 34 relapsed infections, 9 of which experienced a minimum inhibitory concentration change. Median time to first minimum inhibitory concentration change was 56 days (interquartile range 36–88), and type of minimum inhibitory concentration change was an increase in five cases, decrease in two cases, and both increase and decrease in two cases. Minimum inhibitory concentration changes did not result in resistance in S. aureus but did in Pseudomonas aeruginosa and Mycobacterium fortuitum relapsed driveline infection. Time to first relapse from initial infection was longer in those who received suppressive therapy, 60 days versus 83 days, p = 0.047. Relapsed driveline infections were most common with S. aureus. Minimum inhibitory concentration changes were quite variable and may not be the major contributor to relapsed infection in gram-positive driveline infection.

The role of chronic suppressive antibiotics therapy in superficial drive line infection relapse of left ventricular assist devices: A retrospective cohort from a tertiary care center

“…Lines et al reported that DLI with S. aureus is a risk factor for relapse. 19 In our study, we found that relapse was more common in patients infected with MRSA; however patients with MSSA did not have more relapses. This could be due to the fact that vancomycin (the primary treatment for MRSA) may be inferior to betalactams in its anti-staphylococcal activity.…”

Nontuberculous mycobacterial infections in left ventricular assist device patients

“…and Gram-negative bacteria cause most DLIs, 3 but DLIs caused by nontuberculous mycobacterial (NTM) species have recently been reported. [4][5][6][7] We present the second-ever reported case of a DLI caused by Mycobacterium fortuitum in a 75-year-old male with a continuous-flow LVAD. After receiving triple antimycobacterial coverage, he underwent device exchange and ultimately died after failing to recover neurologically.…”

“…Staphylococcal spp. and Gram‐negative bacteria cause most DLIs, 3 but DLIs caused by nontuberculous mycobacterial (NTM) species have recently been reported 4‐7 …”

Mycobacterium abscessus Infection in Left Ventricular Assist Device (LVAD): A Case Series

“…Most LVAD infections are caused by Staphylococcal species, specifically Staphylococcus aureus and Gramnegative bacteria, including Pseudomonas [2][3][4]. Driveline infections, the most common infections in patients with LVADs, occur in 9-48% of patients within 6-8 months of implantation and are associated with increased risk of death [2,5].…”

“…Due to increasing prevalence of heart failure and limited availability of donor organs, implantable left ventricular assist devices (LVADs) are increasingly used as a bridge to heart transplantation, destination therapy, and bridge to recovery [ 1 , 2 ]. Concurrently, the rate of complications from LVAD use is increasing, with LVAD infections becoming a major problem with worsening mortality and increased costs [ 3 ].…”