Pseudomonas aeruginosa LVAD Driveline Infection Acquired from the Bathroom at Home

Abstract

<h3>Introduction</h3> Driveline infections in patients with a left ventricular assist device (LVAD) are feared due to significant morbidity and mortality. There might be great potential in preventive measures at home. <h3>Case Report</h3> A 54-year old patient showed a deep LVAD (HeartMate III) driveline infection by <i>Pseudomonas aeruginosa</i> shortly after his first shower at home. Despite 6 weeks of antibiotics (piperacillin/tazobactam, followed by ceftazidime and ciprofloxacin), surgical intervention was needed due to ongoing inflammation. To find the source of infection, culture swabs were taken from the patient's home bathroom (Figure 1). <i>P. aeruginosa</i> was found in the shower drain, wall-mounted shower jet (<b>B</b>) and non-slip shower mat (<b>D</b>). Typing by Multiple Locus Variable-Numbers Tandem Repeat Analysis to detect genetic congruence, revealed all bathroom strains to be highly similar to the exit site <i>P. aeruginosa</i>. <i>P. aeruginosa</i> thrives in moist environments. Contaminated drains and sinks are known to cause nosocomial infections. Our patient was probably infected at home by upward transmission as both the mat and shower drain tested <i>P. aeruginosa</i> positive<i>.</i> The wall mounted shower jet was positive, but not used. Airborne transmission was not investigated. Preventing driveline infections is important to reduce hospital re-admissions, repeated surgery and costs. We suggest instructions to prevent <i>Pseudomonas</i> infection (Table 1) and increase awareness on infection risks at home. These measures might also be protective for other water-borne pathogens. <h3>Summary</h3> Consider the patient's home bathroom as potential source of <i>P. aeruginosa</i> LVAD driveline infections.