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

Heidi S. Lumish, Barbara Cagliostro, Lorenzo Braghieri, Bruno Bohn, Giulio M. Mondellini, Karen Antler, Vivian Feldman, Audrey Kleet, Jennifer Murphy, Melie Tiburcio, Kathryn Fidlow, Douglas Jennings, Gabriel T. Sayer, Koji Takeda, Yoshifumi Naka, Ryan T. Demmer, Justin G. Aaron, Nir Uriel, Paolo C. Colombo, Melana Yuzefpolskaya

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1450-1458
Number of pages9
JournalASAIO Journal
Volume68
Issue number12
DOIs
StatePublished - Dec 1 2022

Bibliographical note

Funding Information:
This research has been supported by funds from the Lisa and Mark Schwartz Program to Reverse Heart Failure at New York-Presbyterian Hospital/Columbia University.

Funding Information:
Disclosure: P.C.C. is recipient of a research grant from Abbott; he also serves as a consultant for the same company. Y.N. serves as a consultant for Abbott, CryoLife, and Zimmer-Biomet, and as a speaker for Nipro Co. G.T.S. serves as a consultant for Abbott. N.U. serves on advisory boards for Leviticus and Livemetric/Cormetric; he also serves as a consultant for Abbott and Medtronic. The remaining authors have no conflicts of interest to report.

Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.

Keywords

  • chronic antibiotic suppression
  • driveline infection
  • left ventricular assist device
  • mechanical circulatory support

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