Prevalence and management of driveline infections in mechanical circulatory support - a single center analysis
Abstract Background Driveline infections in continuous-flow left ventricular assist devices (cf-LVAD) remain the most common adverse event. This single-center retrospective study investigated the risk factors, prevalence and management of driveline infections. Methods Patients treated after cf-LVAD...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-08-01
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| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13019-021-01589-6 |
| _version_ | 1818607250675073024 |
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| author | Andrzej Juraszek Mikołaj Smólski Piotr Kołsut Jarosław Szymański Paweł Litwiński Krzysztof Kuśmierski Joanna Zakrzewska-Koperska Maciej Sterliński Tomasz Dziodzio Mariusz Kuśmierczyk |
| author_facet | Andrzej Juraszek Mikołaj Smólski Piotr Kołsut Jarosław Szymański Paweł Litwiński Krzysztof Kuśmierski Joanna Zakrzewska-Koperska Maciej Sterliński Tomasz Dziodzio Mariusz Kuśmierczyk |
| author_sort | Andrzej Juraszek |
| collection | DOAJ |
| description | Abstract Background Driveline infections in continuous-flow left ventricular assist devices (cf-LVAD) remain the most common adverse event. This single-center retrospective study investigated the risk factors, prevalence and management of driveline infections. Methods Patients treated after cf-LVAD implantation from December 2014 to January 2020 were enrolled. Baseline data were collected and potential risk factors were elaborated. The multi-modal treatment was based on antibiotic therapy, daily wound care, surgical driveline reposition, and heart transplantation. Time of infection development, freedom of reinfection, freedom of heart transplantation, and death in the follow-up time were investigated. Results Of 75 observed patients, 26 (34.7%) developed a driveline infection. The mean time from implantation to infection diagnosis was 463 (±399; range, 35–1400) days. The most common pathogen was Staphylococcus aureus (n = 15, 60%). First-line therapy was based on antibiotics, with a primary success rate of 27%. The majority of patients (n = 19; 73.1%) were treated with surgical reposition after initial antibiotic therapy. During the follow-up time of 569 (±506; range 32–2093) days, the reinfection freedom after surgical transposition was 57.9%. Heart transplantation was performed in eight patients due to resistant infection. The overall mortality for driveline infection was 11.5%. Conclusions Driveline infections are frequent in patients with implanted cf-LVAD, and treatment does not efficiently avoid reinfection, leading to moderate mortality rates. Only about a quarter of the infected patients were cured with antibiotics alone. Surgical driveline reposition is a reasonable treatment option and does not preclude subsequent heart transplantation due to limited reinfection freedom. |
| first_indexed | 2024-12-16T14:23:46Z |
| format | Article |
| id | doaj.art-c5c3b4651bfc4e30b567f3a5bd095c39 |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-12-16T14:23:46Z |
| publishDate | 2021-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-c5c3b4651bfc4e30b567f3a5bd095c392022-12-21T22:28:26ZengBMCJournal of Cardiothoracic Surgery1749-80902021-08-011611810.1186/s13019-021-01589-6Prevalence and management of driveline infections in mechanical circulatory support - a single center analysisAndrzej Juraszek0Mikołaj Smólski1Piotr Kołsut2Jarosław Szymański3Paweł Litwiński4Krzysztof Kuśmierski5Joanna Zakrzewska-Koperska6Maciej Sterliński7Tomasz Dziodzio8Mariusz Kuśmierczyk9Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszyński National Institute of CardiologyMedical University of WarsawDepartment of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszyński National Institute of CardiologyDepartment of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszyński National Institute of CardiologyDepartment of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszyński National Institute of CardiologyDepartment of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszyński National Institute of Cardiology1st Department of Arrhythmia, The Cardinal Stefan Wyszyński National Institute of Cardiology1st Department of Arrhythmia, The Cardinal Stefan Wyszyński National Institute of CardiologyDepartment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthDepartment of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszyński National Institute of CardiologyAbstract Background Driveline infections in continuous-flow left ventricular assist devices (cf-LVAD) remain the most common adverse event. This single-center retrospective study investigated the risk factors, prevalence and management of driveline infections. Methods Patients treated after cf-LVAD implantation from December 2014 to January 2020 were enrolled. Baseline data were collected and potential risk factors were elaborated. The multi-modal treatment was based on antibiotic therapy, daily wound care, surgical driveline reposition, and heart transplantation. Time of infection development, freedom of reinfection, freedom of heart transplantation, and death in the follow-up time were investigated. Results Of 75 observed patients, 26 (34.7%) developed a driveline infection. The mean time from implantation to infection diagnosis was 463 (±399; range, 35–1400) days. The most common pathogen was Staphylococcus aureus (n = 15, 60%). First-line therapy was based on antibiotics, with a primary success rate of 27%. The majority of patients (n = 19; 73.1%) were treated with surgical reposition after initial antibiotic therapy. During the follow-up time of 569 (±506; range 32–2093) days, the reinfection freedom after surgical transposition was 57.9%. Heart transplantation was performed in eight patients due to resistant infection. The overall mortality for driveline infection was 11.5%. Conclusions Driveline infections are frequent in patients with implanted cf-LVAD, and treatment does not efficiently avoid reinfection, leading to moderate mortality rates. Only about a quarter of the infected patients were cured with antibiotics alone. Surgical driveline reposition is a reasonable treatment option and does not preclude subsequent heart transplantation due to limited reinfection freedom.https://doi.org/10.1186/s13019-021-01589-6Driveline infectionLeft ventricular assist deviceSurgical reposition |
| spellingShingle | Andrzej Juraszek Mikołaj Smólski Piotr Kołsut Jarosław Szymański Paweł Litwiński Krzysztof Kuśmierski Joanna Zakrzewska-Koperska Maciej Sterliński Tomasz Dziodzio Mariusz Kuśmierczyk Prevalence and management of driveline infections in mechanical circulatory support - a single center analysis Journal of Cardiothoracic Surgery Driveline infection Left ventricular assist device Surgical reposition |
| title | Prevalence and management of driveline infections in mechanical circulatory support - a single center analysis |
| title_full | Prevalence and management of driveline infections in mechanical circulatory support - a single center analysis |
| title_fullStr | Prevalence and management of driveline infections in mechanical circulatory support - a single center analysis |
| title_full_unstemmed | Prevalence and management of driveline infections in mechanical circulatory support - a single center analysis |
| title_short | Prevalence and management of driveline infections in mechanical circulatory support - a single center analysis |
| title_sort | prevalence and management of driveline infections in mechanical circulatory support a single center analysis |
| topic | Driveline infection Left ventricular assist device Surgical reposition |
| url | https://doi.org/10.1186/s13019-021-01589-6 |
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