Ventricular Assist Device-Specific Infections

Qu, Yue; Peleg, Anton Y.; McGiffin, David C.

doi:10.3390/jcm10030453

Cited by 15 publications

(27 citation statements)

References 136 publications

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“…As previously reported ( 20 ), DLI peaks 6 months after LVAD implantation. In this meta-analysis, we found a DLI rate of 8.1% at 6 months, making DLI one of the major adverse events after LVAD implantation.…”

Section: Discussionsupporting

confidence: 87%

“…The probability of developing a DLI seems to rise with the duration of LVAD support ( 17 – 19 ) and reaches a peak 6 months after implantation. This could be related to the increased activity of patients after hospital discharge ( 20 ) and the associated increase of trauma at the DLES, which was previously reported as one of the major initiators for DLI ( 21 ). Bending or torsion of the driveline is common during daily activity, e.g., changing of clothes, light exercises, or turning around while sleeping, which could lead to trauma at the DLES ( 4 , 21 ) and rigid materials and large diameters of the driveline could exacerbate this problem.…”

Section: Introductionmentioning

confidence: 91%

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Driveline Features as Risk Factor for Infection in Left Ventricular Assist Devices: Meta-Analysis and Experimental Tests

Kranzl

Stoiber

Schaefer

et al. 2021

Front. Cardiovasc. Med.

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Background: Risk factors for driveline infection (DLI) in patients with left ventricular assist devices are multifactorial. The aim of this study was to analyze the correlation between mechanical driveline features and DLI occurrence.Methods: A meta-analysis was conducted that included studies reporting DLI rates at 6 months after implantation of any of three contemporary devices (HVAD with Pellethane or Carbothane driveline, HeartMate II, and HeartMate 3). Further, outer driveline diameter measurements and ex-vivo experimental three-point bending and torsion tests were performed to compare the stiffness of the four different driveline types.Results: 21 studies with 5,393 patients were included in the meta-analysis. The mean weighted DLI rates ranged from 7.2% (HeartMate II) to 11.9% (HeartMate 3). The HeartMate II driveline had a significantly lower maximal bending force (Loadmax) (4.52 ± 0.19 N) compared to the Carbothane HVAD (8.50 ± 0.08 N), the HeartMate 3 (11.08 ± 0.3 N), and the Pellethane HVAD driveline (15.55 ± 0.14 N) (p < 0.001). The maximal torque (Torquemax) of the HeartMate II [41.44 (12.61) mNm] and the Carbothane HVAD driveline [46.06 (3.78) mNm] were significantly lower than Torquemax of the Pellethane HVAD [46.06 (3.78) mNm] and the HeartMate 3 [95.63 (26.60) mNm] driveline (p < 0.001). The driveline of the HeartMate 3 had the largest outer diameter [6.60 (0.58) mm]. A relationship between the mean weighted DLI rate and mechanical driveline features (Torquemax) was found, as the the HeartMate II driveline had the lowest Torquemax and lowest DLI rate, whereas the HeartMate 3 driveline had the highest Torquemax and highest DLI rate.Conclusions: Device-specific mechanical driveline features are an additional modifiable risk factor for DLI and may influence clinical outcomes of LVAD patients.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 91%

Driveline Features as Risk Factor for Infection in Left Ventricular Assist Devices: Meta-Analysis and Experimental Tests

Kranzl

Stoiber

Schaefer

et al. 2021

Front. Cardiovasc. Med.

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“…is a frequent cause of VAD infections. 17,18 Patients with infected VADs may wait longer for transplantation, particularly those with Enterococcus spp. infective endocarditis.…”

Section: Discussionmentioning

confidence: 99%

Vancomycin‐resistant Enterococcus outbreak in a pre‐ and post‐cardiothoracic transplant population: Impact of discontinuing multidrug‐resistant organism surveillance during the coronavirus disease 2019 pandemic

Rathod

Bardowski

Tse

et al. 2022

Transplant Infectious Dis

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Introduction Many institutions suspended surveillance and contact precautions for multidrug‐resistant organisms (MDROs) at the outset of the coronavirus disease 2019 (COVID‐19) pandemic due to a lack of resources. Once our institution reinstated surveillance in September 2020, a vancomycin‐resistant Enterococcus (VRE) faecium outbreak was detected in the cardiothoracic transplant units, a population in which we had not previously detected outbreaks. Methods An outbreak investigation was conducted using pulsed‐field gel electrophoresis for strain typing and electronic medical record review to determine the clinical characteristics of involved patients. The infection prevention (IP) team convened a multidisciplinary process improvement team comprised of IP, cardiothoracic transplant nursing and medical leadership, environmental services, and the microbiology laboratory. Results Between December 2020 and March 2021, the outbreak involved thirteen patients in the cardiothoracic transplant units, four index cases, and nine transmissions. Of the 13, seven (54%) were on the transplant service, including heart and lung transplant recipients, patients with ventricular assist devices, and a patient on extracorporeal membrane oxygenation as a bridge to lung transplantation. Four of 13 (31%) developed a clinical infection. Discussion Cardiothoracic surgery/transplant patients may have a similar risk for VRE‐associated morbidity as abdominal solid organ transplant and stem cell transplant patients, highlighting the need for aggressive outbreak management when VRE transmission is detected. Our experience demonstrates an unintended consequence of discontinuing MDRO surveillance in this population and highlights a need for education, monitoring, and reinforcement of foundational infection prevention measures to ensure optimal outcomes.

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“…Bacteremia in hemodialysis patients is one of the leading complications 2 in the prerenal transplant population, and bacterial peritonitis is a common occurrence in those on peritoneal dialysis. Up to 40% of ventricular assist devices used in patients awaiting heart transplantation become infected 3,4 and can contribute to substantial in hospital patient stays on long courses of antimicrobials and in some cases until transplantation.…”

Section: Infections In the Solid Organ Transplant Patient Communitymentioning

confidence: 99%

Antimicrobial stewardship in solid organ transplant—Opportunities in the National Health Service

Murthy

Wey

2023

Transplant Infectious Dis

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Background Antimicrobial stewardship (AMS) is an intervention, which ensures the appropriateness of antimicrobial use to avoid in part the rising problem of antimicrobial resistance and negative effects of inappropriate antimicrobial use. In the solid organ transplant (SOT) population, which is prone to a particularly high risk of infection resulting from immunosuppression and anatomical issues with each type of SOT, the need for good stewardship has never been more important. This article looks at current AMS practice in SOT units in the United Kingdom and how things could be improved in the future. Methods The current practice of AMS alongside national antimicrobial resistance rates were reviewed using national mandatory reporting data. The background to the current practice and policies in place in the National Health Service (NHS) were also reviewed and possibilities for future approaches explored. Results AMS is a requirement within all NHS hospitals in the United Kingdom as per government policy. Mandatory reporting of specific bloodstream infections (BSIs) and antimicrobial consumption alongside financial incentives has been the approach nationwide. Gram‐negative resistance rates in BSIs have been increasing prior to the COVID‐19 pandemic. Little SOT‐specific data on antimicrobial resistance exists, and the general approach to AMS in SOT units has generally modeled the national approach. Conclusion Although there is a good, standardized approach to AMS in the NHS, there is a need for SOT‐specific AMS approaches to be developed in the United Kingdom. More data is required on antimicrobial resistance rates, and studies are needed to investigate optimal antimicrobial prophylaxis regimens for each solid organ group. Tools to aid AMS efforts and novel treatment options for complex multiresistant infection must also be explored amongst transplant centers.

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Ventricular Assist Device-Specific Infections

Cited by 15 publications

References 136 publications

Driveline Features as Risk Factor for Infection in Left Ventricular Assist Devices: Meta-Analysis and Experimental Tests

Driveline Features as Risk Factor for Infection in Left Ventricular Assist Devices: Meta-Analysis and Experimental Tests

Vancomycin‐resistant Enterococcus outbreak in a pre‐ and post‐cardiothoracic transplant population: Impact of discontinuing multidrug‐resistant organism surveillance during the coronavirus disease 2019 pandemic

Antimicrobial stewardship in solid organ transplant—Opportunities in the National Health Service

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