Driveline Infection in Left Ventricular Assist Device Patients: Effect of Standardized Protocols, Pathogen Type, and Treatment Strategy.

Autor:	Lumish HS; From the Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York., Cagliostro B; Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota., Braghieri L; From the Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York., Bohn B; Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota., Mondellini GM; From the Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York., Antler K; Department of Surgery, Division of Cardiac Surgery, Columbia University Irving Medical Center, New York, New York., Feldman V; Department of Surgery, Division of Cardiac Surgery, Columbia University Irving Medical Center, New York, New York., Kleet A; Department of Surgery, Division of Cardiac Surgery, Columbia University Irving Medical Center, New York, New York., Murphy J; Department of Surgery, Division of Cardiac Surgery, Columbia University Irving Medical Center, New York, New York., Tiburcio M; Department of Surgery, Division of Cardiac Surgery, Columbia University Irving Medical Center, New York, New York., Fidlow K; Department of Surgery, Division of Cardiac Surgery, Columbia University Irving Medical Center, New York, New York., Jennings D; From the Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York., Sayer GT; From the Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York., Takeda K; Department of Surgery, Division of Cardiac Surgery, Columbia University Irving Medical Center, New York, New York., Naka Y; Department of Surgery, Division of Cardiac Surgery, Columbia University Irving Medical Center, New York, New York., Demmer RT; Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.; Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York., Aaron JG; Department of Medicine Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York., Uriel N; From the Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York., Colombo PC; From the Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York., Yuzefpolskaya M; From the Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York.
Jazyk:	angličtina
Zdroj:	ASAIO journal (American Society for Artificial Internal Organs : 1992) [ASAIO J] 2022 Dec 01; Vol. 68 (12), pp. 1450-1458. Date of Electronic Publication: 2022 Feb 27.
DOI:	10.1097/MAT.0000000000001690
Abstrakt:	Driveline infection (DLI) is common after left ventricular assist device (LVAD). Limited data exist on DLI prevention and management. We investigated the impact of standardized driveline care initiatives, specific pathogens, and chronic antibiotic suppression (CAS) on DLI outcomes. 591 LVAD patients were retrospectively categorized based on driveline care initiatives implemented at our institution (2009-2019). Era (E)1: nonstandardized care; E2: standardized driveline care protocol; E3: addition of marking driveline exit site; E4: addition of "no shower" policy. 87(15%) patients developed DLI at a median (IQR) of 403(520) days. S. aureus and P. aeruginosa were the most common pathogens. 31 (36%) of DLI patients required incision and drainage (I&D) and 5 (5.7%) device exchange. P. aeruginosa significantly increased risk for initial I&D (HR 2.7, 95% CI, 1.1-6.3) and recurrent I&D or death (HR 4.2, 95% CI, 1.4-12.5). Initial I&D was associated with a significant increased risk of death (HR 2.92 (1.33-6.44); P = 0.008) when compared to patients who did not develop DLI. Implementation of standardized driveline care protocol (E2) was associated with increased 2-year freedom from DLI compared to nonstandardized care (HR 0.36, 95% CI, 0.2-0.6, P < 0.01). Additional preventive strategies (E3&E4) showed no further reduction in DLI rates. 57(65%) DLI patients received CAS, 44% of them required escalation to intravenous antibiotics and/or I&D. Presence of P. aeruginosa DLI markedly increased risk for I&D or death. Conditional survival of patients progressing to I&D is diminished. Standardized driveline care protocol was associated with a significant reduction in DLI, while additional preventive strategies require further testing. Competing Interests: Disclosure: P.C.C. is recipient of a research grant from Abbott; he also serves as a consultant for the same company. Y.N. serves as a consultant for Abbott, CryoLife, and Zimmer-Biomet, and as a speaker for Nipro Co. G.T.S. serves as a consultant for Abbott. N.U. serves on advisory boards for Leviticus and Livemetric/Cormetric; he also serves as a consultant for Abbott and Medtronic. The remaining authors have no conflicts of interest to report. (Copyright © ASAIO 2022.)
Databáze:	MEDLINE
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