Abstract
Ventricular assist device (VAD)-specific infections, in particular, driveline infections, are a concerning complication of VAD implantation that often results in significant morbidity and even mortality. The presence of a percutaneous driveline at the skin exit-site and in the subcutaneous tunnel allows biofilm formation and migration by many bacterial and fungal pathogens. Biofilm formation is an important microbial strategy, providing a shield against antimicrobial treatment and human immune responses; biofilm migration facilitates the extension of infection to deeper tissues such as the pump pocket and the bloodstream. Despite the introduction of multiple preventative strategies, driveline infections still occur with a high prevalence of ~10–20% per year and their treatment outcomes are frequently unsatisfactory. Clinical diagnosis, prevention and management of driveline infections are being targeted to specific microbial pathogens grown as biofilms at the driveline exit-site or in the driveline tunnel. The purpose of this review is to improve the understanding of VAD-specific infections, from basic “bench” knowledge to clinical “bedside” experience, with a specific focus on the role of biofilms in driveline infections.
Highlights
Heart failure is a growing public health issue affecting at least 26 million people worldwide [1]
Ventricular assist device (VAD), an electrically powered implantable rotary blood pump, has been used as an advanced treatment for heart failure, either as a “bridge to transplantation” for patients waiting for a donor heart, or as “destination therapy” for those who are ineligible for a heart transplant [2]
Unlike other cardiovascular implantable electronic device (CIED) infections, the occurrence of driveline infections continues for the duration of the implant, with Sharma et al, (2012) reporting the odds of developing a driveline infection rising by 4% for every month of device support [31]
Summary
Heart failure is a growing public health issue affecting at least 26 million people worldwide [1]. Biofilm formation is a major microbial strategy underpinning the pathogenesis andof microBiofilm formation is a major strategy underpinning theskin pathogenesis bial pathogens notmicrobial only initiates infection at the driveline exit-site, butand endows persistence of recalcitrant driveline infections [8,9]. This specific growth model of micropersistence of recalcitrant driveline infections [8,9]. This specific growth model of microbial bial pathogens initiates infection at the driveline skin exit-site, and endows. This review will outline our current understanding of VAD-specific infections, in particular, their pathogenesis, epidemiology, diagnosis, prevention and treatment, and provides guidance on the clinical management of this important complication of VAD implantation
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
