TY - JOUR
T1 - Driveline Infection in Left Ventricular Assist Device Patients
T2 - Effect of Standardized Protocols, Pathogen Type, and Treatment Strategy
AU - Lumish, Heidi S.
AU - Cagliostro, Barbara
AU - Braghieri, Lorenzo
AU - Bohn, Bruno
AU - Mondellini, Giulio M.
AU - Antler, Karen
AU - Feldman, Vivian
AU - Kleet, Audrey
AU - Murphy, Jennifer
AU - Tiburcio, Melie
AU - Fidlow, Kathryn
AU - Jennings, Douglas
AU - Sayer, Gabriel T.
AU - Takeda, Koji
AU - Naka, Yoshifumi
AU - Demmer, Ryan T.
AU - Aaron, Justin G.
AU - Uriel, Nir
AU - Colombo, Paolo C.
AU - Yuzefpolskaya, Melana
N1 - Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/12/1
Y1 - 2022/12/1
N2 - 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.
AB - 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.
KW - chronic antibiotic suppression
KW - driveline infection
KW - left ventricular assist device
KW - mechanical circulatory support
UR - http://www.scopus.com/inward/record.url?scp=85140598616&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85140598616&partnerID=8YFLogxK
U2 - 10.1097/MAT.0000000000001690
DO - 10.1097/MAT.0000000000001690
M3 - Article
C2 - 35239537
AN - SCOPUS:85140598616
SN - 1058-2916
VL - 68
SP - 1450
EP - 1458
JO - ASAIO Journal
JF - ASAIO Journal
IS - 12
ER -