Driveline-related infections after left ventricular assist device implantation: A single center experience

Year 2019, Volume: 10 Issue: 3, 377 - 383, 30.09.2019

Sinan Sabit Kocabeyoğlu , Doğan Emre Sert

https://doi.org/10.18663/tjcl.617027

Abstract

Aim:
The
most common complication after left ventricular assist device
implantation is driveline-induced infections. This complication
severely deteriorates quality of life of the patients. The aim of
this study was to investigate driveline infections in patients with
left ventricular assist device and to introduce our treatment
strategy.

Material
and Methods: Between
May 2013 and October 2018, 90 adult patients who underwent left
ventricular assist device implantation were included. Driveline
infection rates, characteristics, pathogen microorganisms were
investigated. Treatment options for infections were also analyzed.

Results:
The
mean age of the patients was 46.3 ± 13.7 and 83.3% (75/90) were
male. Dilated cardiomyopathy was present in 62.2% of the patients.
Driveline infection was detected in 35.5% (32/90) of the patients.
The mean time between implantation and driveline infection was 304 ±
309 (15-1500) days. The most commonly detected microorganisms from
swabs and/or tissue cultures were gram positive cocci. Seven patients
required oral antibiotic treatment whereas 25 patients required
systemic antibiotic treatment. While infection was controlled by
oral/systemic antibiotic therapy in 13 patients, 15 patients
underwent surgical debridement, three patients required translocation
and heart transplant was required in one patient. None of the
patients had uncontrolled infection requiring device extraction.

Conclusion:
Left
ventricular assist device implantation carries high risk of driveline
infection; In this study, the rate was found to be 24.4% in the first
year. Infection was controlled by oral or systemic antibiotic therapy
and/or debridement therapy in selected cases, driveline translocation
and heart transplant were rarely required.

Keywords

Left ventricular assist device, driveline infection, exit site.

Sol ventrikül destek cihazı implantasyonu sonrası driveline ile ilişkili enfeksiyonlar: Tek merkez deneyimi

Abstract

Amaç:
Sol
ventrikül destek cihazı sonrası görülen en sık komplikasyon
driveline kaynaklı enfeksiyonlardır. Bu komplikasyon hastaların
hayat kalitesini ileri derecede bozmaktadır. Bu çalışmanın amacı
sol ventrikül destek cihazı takılan hastalarda driveline
enfeksiyonlarını araştırmak ve tedavi stratejimizi ortaya
koymaktır.

Gereç
ve Yöntemler: Mayıs
2013 ile Ekim 2018 tarihleri arasında sol ventrikül destek cihazı
takılan 90 erişkin hasta çalışmaya dahil edildi. Driveline
enfeksiyon oranları, özellikleri, patojen mikroorganizmalar
araştırıldı. Ayrıca enfeksiyonlara karşı uygulanan tedavi
seçenekleri incelendi.

Bulgular:
Hastaların
ortalama yaşları 46,3 ± 13,7 idi ve %83,3’ ü (75/90) erkekti.
Hastaların %62,2’ sinde dilate kardiyomiyopati mevcuttu. Tüm
hastaların %35,5’inde (32/90) driveline enfeksiyonu tespit edildi.
İmplantasyon ve driveline enfeksiyonu görülme arasında geçen
ortalama süre 304±309(15-1500) gündü.
Alınan
sürüntü ve/veya doku kültürlerinde en çok tespit edilen
mikroorganizmalar gram pozitif koklar idi. Yedi hastada oral
antibiyotik,
25 hastada ise hastaneye yatırılarak sistemik
antibiyotik tedavisine gereksinim duyuldu. On üç hastada
oral/sistemik antibiyotik tedavisi ile enfeksiyon kontrol altına
alırken 15 hastada ise cerrahi olarak debridman yapıldı, üç
hastada driveline daha yukarı bir bölgeye taşındı ve bir hastaya
kalp nakli gerekti. Hiçbir hastada cerrahi olarak cihazın
çıkarılmasını gerektirecek kontrolsüz enfeksiyona rastlanmadı.

Sonuç:
Sol
ventrikül destek cihazları yüksek oranda driveline enfeksiyonu
oranlarına sahiptir; bu çalışmada oran 1. yılda %24,4 olarak
bulunmuştur. Oral veya sistemik antibiyotik tedavisi ile ve/veya
seçilmiş vakalarda debridman tedavisi ile enfeksiyon kontrol altına
alınmış, nadiren driveline kablosunun taşınması ve kalp nakline
ihtiyaç duyulmuştur.

Keywords

Sol ventrikül destek cihazı, driveline enfeksiyonu, çıkış yeri.

References

• 1. Mozaffarian D, Benjamin EJ, Go AS et al. Heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation 2016; 133: 447-54.
• 2. Genovese EA, Dew MA, Teuteberg JJ et al. Incidence and Patterns of Adverse Event Onset During the First 60 Days After Ventricular Assist Device Implantation. Ann Thorac Surg 2009; 88: 1162–70.
• 3. Koval CE, Thuita L, Moazami N, Blackstone E. Evolution and impact of drive-line infection in a large cohort of continuous-flow ventricular assist device recipients. J Hear Lung Transplant 2014; 33: 1164–72.
• 4. Topkara VK, Kondareddy S, Malik F et al. Infectious complications in patients with left ventricular assist device: etiology and outcomes in the continuousflow era. Ann Thorac Surg 2010; 90: 1270-77.
• 5. Kirklin JK, Pagani FD, Kormos RL et al. Eighth annual INTERMACS report: Special focus on framing the impact of adverse events. J Hear Lung Transplant 2017; 36: 1080–86.
• 6. Goldstein DJ, Naftel D, Holman W et al. Continuous-flow devices and percutaneous site infections: clinical outcomes. J Heart Lung Transplant 2012; 31: 1151-57.
• 7. Pagani FD, Miller LW, Russell SD et al. Extended mechanical circulatory support with a continuous-flow rotary left ventricular assist device. J Am Coll Cardiol 2009; 54: 312-21.
• 8. Gordon RJ, Weinberg AD, Pagani FD et al. Prospective, multicenter study of ventricular assist device infections. Circulation 2013; 127: 691–702.
• 9. Kilic A. The future of left ventricular assist devices. J Thorac Dis 2015; 7: 2188–93.
• 10. Hannan MM, Husain S, Mattner F et al. International Society for Heart and Lung Transplantation. Working formulation for the standardization of definitions of infections in patients using ventricular assist devices. J Heart Lung Transpl 2011; 30: 375–84.
• 11. Pereda D, Conte JV. Left ventricular assist device driveline infections. Cardiol Clin 2011; 29: 515–27.
• 12. Akhter SA, Badami A, Murray M et al. Hospital readmissions after continuous-flow left ventricular assist device implantation: incidence, causes, and cost analysis. Ann Thorac Surg 2015; 100: 884–89.
• 13. Aslam S, Dan J, Topik A et al. Decrease in Driveline Infections with Change in Driveline Management Protocol. VAD J 2016; 2: 1–13.
• 14. Zierer A, Melby SJ, Voeller RK et al. Lateonset driveline infections: the Achilles’ heel of prolonged left ventricular assist device support. Ann Thorac Surg 2007; 84: 515–20.
• 15. Meszaros K, Fuehrer U, Grogg S et al. Risk factors for sternal wound infection after open heart operations vary according to type of operation. Ann Thorac Surg 2016; 101: 1418–25.
• 16. Sharma V, Deo SV, Stulak JM et al. Driveline infections in left ventricular assist devices: implications for destination therapy. Ann Thorac Surg 2012; 94: 1381–86.
• 17. Menon AK, Baranski S-K, Unterkofler J et al. Special Treatment and Wound Care of the Driveline Exit Site after Left Ventricular Assist Device Implantation. Thorac Cardiovasc Surg 2015; 63: 670–74.
• 18. Cagliostro B, Levin AP, Fried J et al. Continuous-flow left ventricular assist devices and usefulness of a standardized strategy to reduce drive-line infections. J Hear Lung Transplant 2016; 35: 108–114.
• 19. Zainah H, Karthikeyan A, Buitron P et al. The Efficacy of Acticoat-Silver Dressing in Preventing Left-entricular-Assisted Device Infections. Immunochem Immunopathol 2016; 2: 2–4.
• 20. Wus L, Manning M, Entwistle III JW, Entwistle JWC. Left ventricular assist device driveline infection and the frequency of dressing change in hospitalized patients. Hear Lung 2015; 44: 225–29.
• 21. Dean D, Kallel F, Ewald GA et al. Reduction in driveline infection rates: Results from the HeartMate II Multicenter Driveline Silicone Skin Interface (SSI) Registry. J Heart Lung Transplant 2015; 34: 781-89 .
• 22. Pavlovic NV, Randell T, Madeira T, Hsu S, Zinoviev R, Abshire M. Risk of left ventricular assist device driveline infection: A systematic literature review. Heart Lung 2019; 48: 90-104.
• 23. Byrd AL, Belkaid Y, Segre JA. The human skin microbiome. Nat Rev 2018; 16: 143– 55.
• 24. Kusne S, Mooney M, Danziger-Isakov L et al. An ISHLT consensus document for prevention and management strategies for mechanical circulatory support infection. J Hear Lung Transplant 2017; 36: 1137–53.