Wound Management of Driveline Infections with Cold Atmospheric Argon Plasma - Proof of Concept

Abstract

Driveline associated infections (DLI) are common in patients supported with ventricular assist devices (VAD). Patients with infections and wound healing disorder are often hospital bound and morbidity and mortality are elevated. The risk for severe bloodstream infection is high as foreign material colonization and multiresistant pathogen are omnipresent. Furthermore, DLI represent an imminent threat to survival and outcome after heart transplantation. Previous studies on the antimicrobial activity of cold atmospheric pressure argon plasma (CAP) showed promising effects against a wide range of pathogens in other fields. This is the first study to analyze the safety and efficiency of CAP in the treatment of DLI. Between 04/2019 and 09/2019 15 male patients with DLI were included. 5 patients with a HVAD and 10 patients with a HeartMate3 LVAD. Bacterial species were detected by standard bacterial swabs. 4 patients were treated in our outpatient VAD clinic. Concomitant antibiotic treatment was administered according to wound swabs. Analysis of 120 CAP treatments in 15 patients for DLI was performed in addition to an extended wound care. The average number of CAP sessions was 7.7 (1-17 sessions/patient). We found a reduction of bacterial load in treated wounds in 9 patients, regardless of the pathogen. The wounds were treated with a mean of 368.5 (120-480) seconds CAP in each session. There was a significant reduction in UTAH wound classification before and after CAP treatment (UTAH 2.80 vs. 1.18; p<0.001), as well as a significant reduction in wound size (16.08 vs. 1.90 cm3; p=0.047). The most common pathogen was staphylococcus aureus, in 8 patients. No adverse effects occurred, and treatment was well tolerated. CAP treatment is a potent, safe and painless supplemental technique to treat DLI without need for repeating surgical interventions. Further studies may support this pilot trial to evaluate details of the applied CAP and outcome measures need to be defined.