Use of Antibiotic Beads in the Treatment of Left Ventricular Assist Device Infections

Abstract

Purpose Infectious complications associated with left ventricular assist devices (LVADs) significantly reduce the quality and length of life while increasing costs and prolonging hospital stays. LVAD pocket infections are associated with a 40-50% mortality rate. There is no widely recognized method for effectively treating such infections other than device removal. Methods and Materials This study is a single-institution, retrospective review of 25 patients with LVAD-associated infections from 2010-2012. Incision and drainage and antibiotic impregnated polymethylmethacrylate (PMMA) beads were implanted in all 25 patients for local antibiotic delivery. Antibiotic beads were exchanged at 1 week intervals until the infected pocket was culture negative. Once the infection was cleared, the infected pocket was revised by repositioning the driveline or covering the pump with a flap. Results Infections were cleared in 16/25 patients (64%), while 9/25 patients (36%) continued to have positive bacterial cultures. Of the 16 patients whose infections were cleared by antibiotic beads, 50% had LVAD pocket infections, and 50% had driveline infections. Rate of re-infection in this group was 3/16 (19%), and overall mortality in the “cleared” group was 19% over the study period. The mortality rate among patients in whom antibiotic beads did not clear the infection was 88% (8/9 patients). There were no significant morbidity differences between the patients whose infections were successfully treated using antibiotic beads and those that were not. Conclusions Compared to other methods, debridement and placement and exchange of antibiotic impregnated beads may be an effective way to manage LVAD device-associated infections. Predicting which patients in whom this technique will successfully clear infections is difficult based upon this case series. However, improved patient survival may result from use of antibiotic beads before internal LVAD infection occurs.