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Impact of narrowing perioperative antibiotic prophylaxis for left ventricular assist device implantation

Lauren Allen1, Rachel Bartash2, Grace Y Minamoto2

  • 1Department of Pharmacy, Montefiore Medical Center, Bronx, New York, USA.

Transplant Infectious Disease : an Official Journal of the Transplantation Society
|July 5, 2022
PubMed
Abstract

Insights

Reducing surgical infection prophylaxis (SIP) for left ventricular assist device (LVAD) patients from four to two drugs did not increase infection rates. This de-escalation strategy for LVAD recipients is safe and effective.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Surgical Innovation

Background:

  • Left ventricular assist device (LVAD) implantation carries a risk of infection, with no standardized surgical infection prophylaxis (SIP) guidelines.
  • A previous 4-drug SIP regimen was revised to a 2-drug regimen (vancomycin and cefazolin) to reduce broad-spectrum antibiotic exposure.

Purpose of the Study:

  • To evaluate the impact of revising the SIP regimen on LVAD-associated infection rates.
  • To compare infection rates and mortality before and after the implementation of a de-escalated antibiotic protocol.

Main Methods:

  • A retrospective review of 71 patients who underwent LVAD implantation between January 2018 and April 2021.
  • Infection rates were analyzed at 2 weeks, 30 days, and 90 days post-implantation for both the 4-drug and 2-drug SIP regimens.
  • Infections were classified using International Society for Heart and Lung Transplantation definitions.

Main Results:

  • No significant difference in LVAD-associated infection rates was observed between the 4-drug and 2-drug SIP groups at 2 weeks, 30 days, or 90 days.
  • Gram-negative and fungal infections were uncommon in both groups. Staphylococcus aureus was the most frequent pathogen, and pneumonia was the most common infection type.
  • There was no statistically significant difference in 30 or 90-day mortality between the two SIP regimens.

Conclusions:

  • De-escalation of perioperative antibiotics in LVAD patients did not lead to increased infection rates or mortality.
  • The findings suggest that a 2-drug SIP regimen is a viable alternative to broader antibiotic protocols.
  • Larger studies are recommended to further validate these results and inform clinical practice.
Keywords:
LVAD-associated infectionsantimicrobial stewardshipdevice infectionleft ventricular assist devicessurgical infection prophylaxissurgical site infections

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