Abstract
Purpose Driveline infections (DLI) commonly complicate LVAD therapy. We sought to describe the impact of DLI over time in a large cohort of continuous flow LVAD recipients. Methods and Materials All patients with first HeartMate II (HMII) LVAD from 7/2004 to 7/2011 at our institution were included. Electronic medical records were reviewed for infection details to supplement data available in our transplant databases. DLIs were defined according to Hannan, et al (2011). Results From 7/04 to 7/11, 181 LVADs were implanted and 44 DLIs occurred during 304 person-years of LVAD support. Hazard for DLI after LVAD was constant at 2.2%/mo but increased to 10%/mo from 6-9 months. [ figure 1 ] Pre-, peri-, post-operative variables did not correlate with risk for DLI. “Trauma” to drive line was described in 20/44 (45%) of DLI vs. 3/137 (2.1%) without DLI but this was not routinely documented. DLI doubled the risk for death before transplant (HR 2.16, CI95% 1.18, 3.96). Pseudomonas aeruginosa (PA) was the most common pathogen and often replaced initial pathogens over time. Superficial DLI progressed at a mean 173d (61-362d) to deep DLI in 9/39 (23%), 8/9 due to PA, 1/9 Staphylococcus aureus . Multidrug resistance emerged in 4 PA and 3 other gram negative DLIs. Other complications of antibiotics rarely occurred. Conclusions DLI prevalence accumulates over time in patients on LVAD support. Our data demonstrate a peak hazard of DLI from 6-9 months after implantation. DLI is an independent predictor of death before transplantation in our population. PA, more than other organisms, progressed to deep DLI and became more drug resistant over time on support.
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