Prevention and early treatment of driveline infections in ventricular assist device patients – The DESTINE staging proposal and the first standard of care protocol

Bernhardt, A.; Schlöglhofer, Thomas; Lauenroth, Volker; Mueller, Florian; Mueller, Marcus; Schoede, Alexandra; Klopsch, Christian

doi:10.1016/j.jcrc.2019.12.014

Cited by 57 publications

(62 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…6 LVAD-related percutaneous driveline infections were defined 7 as those requiring antimicrobial therapy when there were clinical signs of infection such as pain, fever, drainage from the exit-site, and/or leukocytosis. As proposed by the Sharp Memorial group 8 or the DESTINE staging proposal, 9 DLI classification of stages 1 to 5 may be useful for the discussion of treatment strategy. If DLI was suspected, a complete infectious workup including information on bacterial cultures and daily wound care with a sterile silver-impregnated dressing (AQUACEL Ag, ConvaTec, Munich, Germany) was performed for early treatment (stage 1 or 2) in the NRDLI cohort without readmission.…”

Section: Definition Of Lvad-related Infections and Infection Managementioning

confidence: 99%

Left ventricular assist device driveline infections in three contemporary devices

et al. 2020

Self Cite

View full text Add to dashboard Cite

Ventricular assist devices (VADs) are an established therapeutic option 1 for patients with end-stage heart failure and provide circulatory support until myocardial recovery, heart transplantation or as destination therapy. Over the last decade, mechanical circulatory support has further improved patient survival and quality of life due to improvements in the design and durability of the devices. 2 However, infection remains a major adverse event and a relevant cause of morbidity and mortality in VAD recipients 2 with considerable best practices variation regarding infection prevention and management and driveline exit site care. 3,4 Infection occurs in up to 60% of VAD patients 4 and is the most frequent adverse event during the first 3 months

show abstract

Section: Definition Of Lvad-related Infections and Infection Managementioning

confidence: 99%

Left ventricular assist device driveline infections in three contemporary devices

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…34 It is important to highlight trauma as a leading cause of DLI 13,28,29 necessitating suture anchoring DLES during the first 2 weeks, and after its removal adhesive anchoring devices for driveline immobilization. 14,29,33,56,66 Many centers of expertise in VAD implantation and management follow general cardiac surgery guidelines in perioperative prophylaxis using firstand second-generation cephalosporins (cefazoline or cefuroxime) for 24 to 48 hours covering Gram-positive and Gram-negative bacteria, 4,67 whereas antifungal prophylaxis is not a routine. 68 In patients allergic to β-lactams and/or cephalosporins, clindamycin or vancomycin is an acceptable alternative covering Grampositive pathogens.…”

Section: Prevention Measuresmentioning

confidence: 99%

Ventricular Assist Device Driveline Infections: A Systematic Review

Krželj

Petričević

Gašparović

et al. 2021

Thorac Cardiovasc Surg

View full text Add to dashboard Cite

Infection is the most common complication in patients undergoing ventricular assist device (VAD) implantation. Driveline exit site (DLES) infection is the most frequent VAD infection and is a significant cause of adverse events in VAD patients, contributing to morbidity, even mortality, and repetitive hospital readmissions. There are many risk factors for driveline infection (DLI) including younger age, smaller constitution of patients, obesity, exposed velour at the DLES, longer duration of device support, lower cardiac index, higher heart failure score, DLES trauma, and comorbidities such as diabetes mellitus, chronic kidney disease, and depression. The incidence of DLI depends also on the device type. Numerous measures to prevent DLI currently exist. Some of them are proven, whereas the others remain controversial. Current recommendations on DLES care and DLI management are predominantly based on expert consensus and clinical experience of the certain centers. However, careful and uniform DLES care including obligatory driveline immobilization, previously prepared sterile dressing change kits, and continuous patient education are probably crucial for prevention of DLI. Diagnosis and treatment of DLI are often challenging because of certain immunological alterations in VAD patients and microbial biofilm formation on the driveline surface areas. Although there are many conservative and surgical methods described in the DLI treatment, the only possible permanent solution for DLI resolution in VAD patients is heart transplantation. This systematic review brings a comprehensive synthesis of recent data on the prevention, diagnostic workup, and conservative and surgical management of DLI in VAD patients.

show abstract

“…However, in March 2019, cf-LVAD coordinators and cardiac surgeons from Germany and Austria prepared a 10-step procedure for driveline care. An advanced wound staging approach was defined with recommended actions for the prevention, early detection, and stage-related management of driveline infections [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…If all other strategies fail, heart transplantation is applied as last treatment resort [ 6 , 7 ]. Currently, data regarding the treatment strategies and outcome of complications related to driveline infections is limited [ 6 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and management of driveline infections in mechanical circulatory support - a single center analysis

Juraszek

Smólski

Kołsut

et al. 2021

J Cardiothorac Surg

View full text Add to dashboard Cite

Background Driveline infections in continuous-flow left ventricular assist devices (cf-LVAD) remain the most common adverse event. This single-center retrospective study investigated the risk factors, prevalence and management of driveline infections. Methods Patients treated after cf-LVAD implantation from December 2014 to January 2020 were enrolled. Baseline data were collected and potential risk factors were elaborated. The multi-modal treatment was based on antibiotic therapy, daily wound care, surgical driveline reposition, and heart transplantation. Time of infection development, freedom of reinfection, freedom of heart transplantation, and death in the follow-up time were investigated. Results Of 75 observed patients, 26 (34.7%) developed a driveline infection. The mean time from implantation to infection diagnosis was 463 (±399; range, 35–1400) days. The most common pathogen was Staphylococcus aureus (n = 15, 60%). First-line therapy was based on antibiotics, with a primary success rate of 27%. The majority of patients (n = 19; 73.1%) were treated with surgical reposition after initial antibiotic therapy. During the follow-up time of 569 (±506; range 32–2093) days, the reinfection freedom after surgical transposition was 57.9%. Heart transplantation was performed in eight patients due to resistant infection. The overall mortality for driveline infection was 11.5%. Conclusions Driveline infections are frequent in patients with implanted cf-LVAD, and treatment does not efficiently avoid reinfection, leading to moderate mortality rates. Only about a quarter of the infected patients were cured with antibiotics alone. Surgical driveline reposition is a reasonable treatment option and does not preclude subsequent heart transplantation due to limited reinfection freedom.

show abstract

Prevention and early treatment of driveline infections in ventricular assist device patients – The DESTINE staging proposal and the first standard of care protocol

Cited by 57 publications

References 23 publications

Left ventricular assist device driveline infections in three contemporary devices

Left ventricular assist device driveline infections in three contemporary devices

Ventricular Assist Device Driveline Infections: A Systematic Review

Prevalence and management of driveline infections in mechanical circulatory support - a single center analysis

Contact Info

Product

Resources

About