Clinical Outcomes Associated With Chronic Antimicrobial Suppression Therapy in Patients With Continuous‐Flow Left Ventricular Assist Devices

Abstract

This retrospective cohort study evaluates the effect of chronic antimicrobial suppression (CAS) therapy on clinical outcomes in patients with continuous-flow left ventricular assist devices (CF-LVADs) and a history of device-related infection. Patients with CF-LVAD implantation between January 2008 and August 2011 who received systemic CAS after index antibiotic treatment of a device-related infection were included. Chronic suppression was defined as continuation of antibiotics for longer than 6 weeks after the index infection. Standard International Society for Heart and Lung Transplantation definitions were used. The primary outcome is failure of CAS, defined as a clinical deterioration resulting in the need for transition from oral to intravenous (IV) therapy or a need to change to a different IV antibiotic, elevation to status 1A on the transplant list as a result of ongoing infection, or device/driveline exchange. Of 140 patients screened, 16 patients were included (69% male, 63% African American, median age 52 years). The driveline was the most common site of infection (69%). Organisms isolated included Gram-positive cocci (n = 7), Gram-negative bacilli (n = 10), and Candida (n = 1). Oral trimethoprim/sulfamethoxazole treatment was most commonly used for suppression (37.5%). Failure of CAS occurred in 5/16 (31%) patients after a mean time of 175 days on therapy (range 10-598). The majority of failures (60%) required device exchanges. Side effects of nausea, vomiting, or diarrhea were reported in three patients; all required changes in oral suppression regimen. Clostridium difficile infection was noted in two patients. These results, which must be confirmed by a larger analysis, suggest that one-third of CF-LVAD patients may develop recurrent infections while on CAS therapy.

A Review of Infections in Patients with Left Ventricular Assist Devices: Prevention, Diagnosis and Management

“…24 While device exchange can be performed for severe cases, recurrences are common with this treatment as well. 12,25 Expediting heart transplant listing in patients with PSI may be a good option in appropriate candidates.…”

Therapy and Outcome of Staphylococcus aureus Infections of Intracorporeal Ventricular Assist Devices

“…Over the last years, several reports have been published describing incidence, risk factors and general management of VAD infections , but details of antibiotic policies have thus far mostly been described in case reports and small case series . This study, therefore, retrospectively assessed the antibiotic treatment and the outcome of VAD‐infections caused by S. aureus , the most frequent and the most virulent pathogen in our population.…”

Device exchange versus nonexchange modalities in left ventricular assist device‐specific infections: A systematic review and meta‐analysis

“…While LVAD-specific infections continue to occur at a high rate in CF-LVAD recipients, there remains no standardized treatment algorithm (14,15). Many treatment modalities have been attempted, including antibiotics alone or in combination with incision and drainage, muscle flap, driveline relocation, omentoplasty, and device exchange (16,17).…”