Importance of early appropriate intervention including antibiotics and wound care for device-related infection in patients with left ventricular assist device.
BACKGROUND
A left ventricular assist device (LVAD) is essential for treating patients with advanced heart failure. However, LVAD-related infection is a significant cause of mortality and morbidity, with bloodstream infection (BSI) especially associated with high mortality. We investigated the incidence of infectious complications in patients who received an LVAD and evaluated the effects of early and appropriate intervention for LVAD-related infection.


METHODS
We retrospectively reviewed 27 consecutive patients who underwent continuous-flow LVAD (CF-LVAD; n = 16) or pulsatile-flow LVAD (PF-LVAD; n = 11) implantation at the National Cerebral and Cardiovascular Center between April 2011 and March 2013. Incidences of LVAD-related infections, such as drive-line infection in patients with CF-LVAD, cannula infection in patients with PF-LVAD, and BSI in patients with both types, were examined (follow-up period, 342 ± 229 days). The mandatory antibiotic prophylaxis protocol at our institution includes teicoplanin (400 mg) 2 days before LVAD implantation and doripenem (1000 mg) within 1 hour of skin incision. In addition, the driveline exit sites undergo sterile cleansing with diluted hydrogen peroxide and placement of an antimicrobial occlusive dressing for wound care, with dressing changes performed 2-3 times per day.


RESULTS
More than 90% of all patients suffered from a drive-line infection within 12 months after LVAD implantation. However, BSI developed in only 12.5% of CF-LVAD and 10% of PF-LVAD patients within 12 months (log-rank test; P = .875).


CONCLUSIONS
LVAD-related infections, such as drive-line and cannula infections, were common, whereas the incidence of BSI was low in our LVAD-implanted patients. Our results highlight the importance of early and appropriate intervention including antibiotics and wound care for device-related infections for reducing the incidence of potentially fatal BSI.
Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan. Electronic address: hieda_michinari_0119@yahoo.co.jp.
M
M
Hieda
Department of Pulmonology and Infection Control, National Cerebral and Cardiovascular Center, Osaka, Japan.
M
M
Sata
Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
O
O
Seguchi
Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
M
M
Yanase
Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
Y
Y
Murata
Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
T
T
Sato
Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
H
H
Sunami
Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
S
S
Nakajima
Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
T
T
Watanabe
Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
Y
Y
Hori
Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
K
K
Wada
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
H
H
Hata
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
T
T
Fujita
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
J
J
Kobayashi
Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
T
T
Nakatani
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000209:etiology* / Q000382:microbiology; D015780:Carbapenems / Q000008:administration & dosage; D000077726:Doripenem; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D017334:Teicoplanin / Q000008:administration & dosage; D014947:Wounds and Injuries / Q000628:therapy*
D000900:Anti-Bacterial Agents; D015780:Carbapenems; D017334:Teicoplanin; D000077726:Doripenem