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Stopping conventional showering decreases Pseudomonas infections in left ventricular assist device patients
Nana Aburjania1, Saadia Sherazi2, Vakhtang Tchantchaleishvili3
1Division of Infectious Diseases, University of Rochester School of Medicine and Dentistry, Rochester, NY - USA.
Background:
Left ventricular assist device (LVAD) exit-site infections represent a major challenge in the era of modern LVADs. Infections caused by Pseudomonas are particularly difficult to treat due to limited antibiotic susceptibility. We hypothesized that keeping the LVAD exit site dry while bathing could result in reduced incidence of Pseudomonas infections.
Methods:
Starting in April 2013, all patients who underwent placement of HeartMate II (HM II) LVAD were instructed not to take conventional showers and to keep the exit site dry while bathing. We retrospectively reviewed patients who underwent HeartMate II LVAD implantation at our institution. Overall and Pseudomonas exit-site infections were compared between two groups: Group 1 was implanted with an LVAD prior to intervention (4/1/2013) and Group 2 after the intervention. Both groups were subjected to cumulative hazard analysis and compared using log-rank test.
Results:
From November 2006 to September 2015, 283 patients underwent HM II LVAD placement at a single institution (Group 1, 163 patients; Group 2, 120 patients). Median age was 59 years (interquartile range [IQR] 50-65), and 57 (20%) were female. Overall, driveline infection was noted in 86 (30%) patients. Pseudomonas was the causative or coexisting organism in 16 (6%) patients. Median days to infection were 347 (IQR, 162-568). Driveline infection was identified in 69 (42%) patients in Group 1 and 17 (14 %) in Group 2. Pseudomonas was an infectious organism in 15 (9%) patients of Group 1 and one (1%) patient of Group 2. The incidence of Pseudomonas exit-site infections (p = 0.077) decreased substantially after the intervention.
Conclusions:
Stopping conventional showering may reduce the rate of Pseudomonas LVAD exit-site infections. Additional, multi-institutional data are needed to further evaluate these findings.
Insights
Keeping left ventricular assist device (LVAD) exit sites dry during bathing significantly reduced Pseudomonas infections. This simple bathing modification offers a promising strategy for preventing difficult-to-treat LVAD infections.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Devices
Background:
- Left ventricular assist device (LVAD) exit-site infections pose a significant clinical challenge.
- Pseudomonas infections are particularly difficult to manage due to limited antibiotic options.
Purpose of the Study:
- To investigate if maintaining a dry LVAD exit site during bathing reduces Pseudomonas infections.
- To evaluate the impact of a specific bathing intervention on LVAD exit-site infection rates.
Main Methods:
- A retrospective review of HeartMate II (HM II) LVAD patients was conducted.
- Patients were divided into two groups: pre-intervention (conventional showering) and post-intervention (dry exit site during bathing).
- Cumulative hazard analysis and log-rank tests were used to compare infection rates.
Main Results:
- The incidence of overall driveline infections decreased from 42% to 14% post-intervention.
- Pseudomonas exit-site infections decreased significantly from 9% in the pre-intervention group to 1% in the post-intervention group (p = 0.077).
- The median time to infection was 347 days.
Conclusions:
- Implementing a dry-bathing protocol for LVAD exit sites may lower the incidence of Pseudomonas infections.
- Further multi-institutional studies are warranted to validate these findings.
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