Driveline infections in left ventricular assist devices-Incidence, epidemiology, and staging proposal

BackgroundDriveline infections (DLI) are a serious complication in patients with left ventricular assist devices (LVAD). Apart from the differentiation between superficial and deep DLI, there is no consensus on the classification of the severity of DLI. Little is known about risk factors and typical bacteria causing DLI in centrifugal-flow LVADs.MethodsIn this single-center study with 245 patients, DLI were classified by their local appearance using a modification of a score suggested by the Sharp Memorial group. The driveline exit site was inspected routinely every 6 months.ResultsSevere DLI were detected in 34 patients (15%) after 6 months and in 24 patients (22%) after 24 months. The proportion of patients with DLI increased significantly during the follow-up (p = 0.0096). The most common bacteria in local smears were Corynebacterium, coagulase-negative Staphylococcus, and Staphylococcus aureus. Fifty-nine patients were hospitalized more than once for DLI. In these patients, S. aureus was the most common bacterium. It was also the most common bacterium in blood cultures. Higher BMI, no partnership, and a HeartMate 3 device were identified as risk factors for DLI in a multivariable cause-specific Cox regression.ConclusionThis study is a standardized analysis of DLI in a large cohort with centrifugal-flow LVADs. In this single-center study with 245 patients with left ventricular assist devices, driveline infections (DLI) were classified by their local appearance using a modification of a score suggested by the Sharp Memorial group. The proportion of patients with DLI increased significantly during the follow-up (p = 0.0096). Higher BMI, no partnership, and a HeartMate 3 device were identified as risk factors for DLI in a multivariable cause-specific Cox regression.image