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Topical Polymyxin-Trimethoprim Prophylaxis May Decrease the Incidence of Driveline Infections in Patients With
Marlene L Durand1, Stephanie C Ennis2, Joshua N Baker3
1Infectious Disease Unit, Department of Medicine, Massachusetts General Hospital, MA, Boston, USA.
Artificial Organs
|April 22, 2016
Summary
Topical polymyxin-trimethoprim (poly) prophylaxis significantly reduced driveline infections (DLIs) in left ventricular assist device patients. This study found poly use lowered DLI incidence, especially deep infections, and prevented bacteremia.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Devices
Background:
- Driveline infections (DLIs) are a significant complication in patients with continuous-flow left ventricular assist devices (CF-LVADs).
- Preventing DLIs is crucial for improving patient outcomes and device longevity.
Purpose of the Study:
- To evaluate the efficacy of topical polymyxin-trimethoprim (poly) prophylaxis in reducing the incidence of DLIs in CF-LVAD patients.
- To assess the impact of poly prophylaxis on DLI-related bacteremia and infection severity.
Main Methods:
- Retrospective cohort study of 84 CF-LVAD patients implanted between 2005 and 2014 with device support of at least 30 days.
- Comparison of DLI incidence between patients receiving topical polymyxin-trimethoprim (poly group, n=65) and those who did not (no-poly group, n=19).
- Kaplan-Meier analysis was used to compare freedom from DLIs between the groups.
Main Results:
- The poly group showed a significantly lower incidence of DLIs compared to the no-poly group (P < 0.0001).
- Topical poly prophylaxis was associated with a 75% reduction in overall DLI incidence and a 95% reduction in deep DLIs (P ≤ 0.001).
- No DLI-related bacteremia occurred in the poly group, versus 11% in the no-poly group.
Conclusions:
- Topical polymyxin-trimethoprim prophylaxis appears effective in preventing driveline infections in patients with continuous-flow left ventricular assist devices.
- The findings suggest that poly prophylaxis may reduce the risk of deep DLIs and associated bacteremia.
- Larger comparative studies are recommended to confirm these findings.
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