Driveline Infections after LVAD Implantation.

PURPOSE: After implantation of a Left Ventricular Assist Device (LVAD), driveline infection remains one of the most common complications. Early recognition and treatment of these infections is of great importance in the prevention of substantial morbidity and mortality. The purpose of this study is to determine the incidence and outcome of these driveline infections. METHODS: Data have been retrospectively collected from 159 patients with LVAD implantation and follow-up between March 2007 and February 2018 at Leuven University Hospital, Belgium. Cultures from the driveline exit site were taken when clinical signs of infection were present. Infection was defined as a positive wound culture and treatment with antibiotics. RESULTS: A total of 135 infections were documented in 67 patients (42.1%). In the first year after implantation there was an incidence rate of 6.3 infections per 100 patients months. Recurrence of infection was documented in 53.7% of these patients. The first event occurred after 245 ± 253 days. The most common bacterial pathogens to cause driveline infection included Staphylococcus aureus (44%), Staphylococcus epidermidis (7%) and pseudomonas aeruginosa (5%). Chronic antimicrobial therapy was given to 49.2% of patients with an infection. CONCLUSION: A first infection of the driveline presents after a mean time of 245 days, which shows that the incidence of driveline infections is highest in the first year after LVAD implantation and that most events occur after discharge from the hospital. Recurrence of infection was observed in approximately 50% of patients. The most common pathogen causing driveline infection is Staphylococcus. Prevention should be focused on the out-patients setting. In case of a clinical suspicion of infection, blind antibiotic treatment of these infections should focus on Staphylococcus until a specific pathogen is isolated from the wound culture.

Publication year:2020

Accessibility:Closed