title: Prevention of percutaneous driveline infection after left ventricular assist device implantation: prophylactic antibiotics are not necessary.
abstract: Infection is a major source of morbidity and mortality after ventricular assist device (VAD) implantation. The percutaneous driveline is the most common site of infection in these patients and often serves as a portal to deeper pump infections. There are no data defining the role of prophylactic antibiotics in preventing these infections. We compared all patients who underwent primary HeartMate II VAD implantation at two different institutions employing two different driveline infection prevention strategies between February 2007 and September 2011. While all patients received perioperative antibiotics, driveline maintenance strategies included sterile dressing changes with Hibiclens application without continued prophylactic antibiotics (Abx) (Mayo Clinic, n = 141, No Abx) and sterile dressing changes with continued prophylactic antibiotics (University of Michigan Hospital, n = 144, Abx). Although gender was similar between cohorts (Abx: 79% male vs. No Abx: 84% male, p = 0.25), median age at implant (Abx: 59 vs. No Abx: 64, p = 0.001) and destination therapy as indication for VAD (Abx: 22% vs. No Abx: 60%, p < 0.001) were significantly different. Follow-up was available in all late survivors (Abx: 140 patients, No Abx: 127 patients). Median duration of support was similar between groups (Abx: 12.3 months vs. No Abx: 11 months, p = 0.44). Total patient-years of device support were 172 years for 140 patients in the Abx cohort and 146 years for 127 patients in the No Abx cohort. Driveline drainage/infection was observed in 25 of 140 patients (18%) in the Abx group and 16 of 127 (13%) in the No Abx group (p = 0.15). Device exchange for major driveline infection was performed in seven patients in the Abx group and 0 patients in the No Abx group. Total driveline infection events per patient-years of support were 0.15 for the Abx group and 0.11 in the No Abx group (p = 0.43). There was no significant difference in the raw incidence of major driveline infections or driveline infections per patient-years of support in patients who were maintained on prophylactic antibiotics compared with those who were not. These data suggest that other factors may be more important than prophylactic antibiotics in preventing driveline infections.
authors.affiliation: From the *Mayo Clinic College of Medicine, Rochester, MN; †Vanderbilt University Hospital, Nashville, TN; and ‡University of Michigan Health System, Ann Arbor, MI.
authors.forename: John M
authors.initials: JM
authors.lastname: Stulak
authors.forename: Simon
authors.initials: S
authors.lastname: Maltais
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cowger
authors.forename: Lyle D
authors.initials: LD
authors.lastname: Joyce
authors.forename: Richard C
authors.initials: RC
authors.lastname: Daly
authors.forename: Soon J
authors.initials: SJ
authors.lastname: Park
authors.forename: Keith D
authors.initials: KD
authors.lastname: Aaronson
authors.forename: Francis D
authors.initials: FD
authors.lastname: Pagani
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000401:mortality / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents