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Single Versus Multidrug Regimen for Surgical Infection Prophylaxis in Left Ventricular Assist Device Implantation
Nana Aburjania1, Brennan M Ertmer2, Saira Farid1
1From the Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|November 3, 2017
Summary
For left ventricular assist device (LVAD) implantation, single-drug surgical infection prophylaxis (SIP) showed no clear benefit over multidrug regimens in preventing LVAD infections or improving survival. Further trials are needed to establish optimal SIP protocols.
Area of Science:
- Cardiology
- Infectious Diseases
- Surgical Innovation
Background:
- Infection remains a significant complication for patients receiving left ventricular assist device (LVAD) therapy.
- Optimal antimicrobial surgical infection prophylaxis (SIP) regimens for LVAD implantation are not yet well-established, necessitating further research.
Purpose of the Study:
- To compare the efficacy of single-drug versus multidrug antimicrobial surgical infection prophylaxis (SIP) regimens in preventing left ventricular assist device infections (LVAIs) and improving survival.
- To evaluate the impact of different SIP strategies on infection-free survival and all-cause mortality in LVAD recipients.
Main Methods:
- A retrospective review of adult patients who underwent continuous-flow LVAD implantation between February 2007 and March 2015.
- Comparison of LVAD-specific and LVAD-related infections, and all-cause mortality between single-drug and multidrug SIP groups using Kaplan-Meier analyses.
- Exclusion of patients with non-HeartMate II/HeartWare devices, incomplete SIP data, or active infections at implantation.
Main Results:
- No significant difference in LVAD infection rates at 90 days between single-drug (1.5%) and multidrug (5.0%) SIP groups (p = 0.4).
- No statistically significant difference in infection-free survival (p = 0.4) or overall survival (p = 0.9) at 1 year between the two SIP groups.
- The study included 199 patients on single-drug SIP and 40 patients on multidrug SIP.
Conclusions:
- Current findings suggest no clear benefit of multidrug SIP over single-drug SIP for preventing LVAD infections or improving survival.
- Prospective clinical trials are essential to definitively establish the optimal surgical infection prophylaxis regimen for LVAD implantation.
- The study highlights the need for evidence-based guidelines regarding antimicrobial prophylaxis in LVAD surgery.
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