Topical Polymyxin-Trimethoprim Prophylaxis May Decrease the Incidence of Driveline Infections in Patients With Continuous-Flow Left Ventricular Assist Devices.
This retrospective cohort study evaluated the effect of topical polymyxin-trimethoprim (poly) prophylaxis on the incidence of driveline infections (DLIs) in patients with continuous-flow left ventricular assist devices. All 84 cases implanted 2005-2014 with device support ≥30 days were reviewed; support ranged 1 m-5.2 yrs. Beginning 2008, poly was applied to the exit site with dressing changes. Sixty-five patients received poly (poly group) for duration of follow-up, 19 did not (no-poly); group baseline characteristics were similar. No patient developed side effects from poly. Nineteen DLIs (10 in no-poly) occurred; not using poly was a risk factor. 89% of poly group DLIs were superficial, 4 were culture-negative. DLI-related bacteremia occurred in 11% of no-poly group and 0% of poly group. Compared with no-poly, poly group demonstrated improved freedom from DLI by Kaplan-Meier analysis (P < 0.0001) and a 75% lower overall and 95% lower deep DLI incidence (P ≤ 0.001). Deep DLIs occurred in 31.6% of no-poly vs. 1.5% of poly patients (P = 0.0004), although mean support duration (1 yr) and % support >1 yr (38%) were similar. These findings, which should be confirmed with larger comparative studies, suggest that topical polymyxin-trimethoprim prophylaxis may be effective in preventing DLIs.
Infectious Disease Unit, Department of Medicine, Massachusetts General Hospital, MA, Boston, USA.
Marlene L
ML
Durand
Department of Cardiac Surgery, Massachusetts General Hospital, MA, Boston, USA.
Stephanie C
SC
Ennis
Department of Cardiothoracic Surgery, Missouri Baptist Medical Center, St. Louis, MO, USA.
Joshua N
JN
Baker
Department of Cardiac Surgery, Massachusetts General Hospital, MA, Boston, USA.
Janice M
JM
Camuso
Department of Cardiac Surgery, Massachusetts General Hospital, MA, Boston, USA.
Kathleen M
KM
McEachern
Infectious Disease Unit, Department of Medicine, Massachusetts General Hospital, MA, Boston, USA.
Camille N
CN
Kotton
Cardiology Division, Massachusetts General Hospital, MA, Boston, USA.|Department of Medicine, Massachusetts General Hospital, Boston, MA.
Gregory D
GD
Lewis
Department of Cardiac Surgery, Massachusetts General Hospital, MA, Boston, USA.
Jose P
JP
Garcia
Department of Cardiac Surgery, Massachusetts General Hospital, MA, Boston, USA.
Thomas E
TE
MacGillivray
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011113:Polymyxins / Q000008:administration & dosage / Q000627:therapeutic use*; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D014295:Trimethoprim / Q000008:administration & dosage / Q000627:therapeutic use*; D055815:Young Adult
D000900:Anti-Bacterial Agents; D011113:Polymyxins; D014295:Trimethoprim
Chronic antibiotic suppression; Driveline infection; Left ventricular assist device; Topical antibiotics