Prophylactic Use for Driveline Infections: Can we Prevent Infection Resulting from Trauma?

Abstract

Driveline infections in patients with left ventricular assist devices (LVAD) have long been an adverse event that has been difficult to eliminate. Driveline infections lead to an increased morbidity and mortality and a decrease in quality of life for patients. This review served to determine if using antibiotics as prophylactic therapy can affect infection rates and increase survival in patients who have had trauma or manipulation of the driveline. Trauma or manipulation can consist of a controller drop, driveline tug. A retrospective chart review was done at a large academic medical center. We reviewed all patients implanted with an LVAD within the past 5 years. Patients were divided by infection vs non-infection; patients were then evaluated by who was treated with prophylactic antibiotic therapy and who developed an infection post antibiotic therapy compared to patients that developed an infection with no prophylactic therapy. We then reviewed survival rates within that cohort of patients. A total of 258 patients were evaluated for driveline infection. Of those, 73 (28%) patients had developed a driveline infection. Of those 73, 62 (84%) were not treated with prophylactic antibiotic therapy and 11 (15%) received prophylactic antibiotics. Mortality within the group of patients with no prophylaxis therapy was 25 (40%) vs 1 (9%) p=0.03 in the patients that were treated with prophylaxis antibiotic therapy. Prophylactic antibiotic therapy can be useful to prevent driveline infections and increase survival in patients with a known controller drop or driveline tug. Further studies should be done to evaluate further prophylactic antibiotic therapy in other cohorts of patients.