From the Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
Department of Pharmacy Services, Mayo Clinic, Rochester, Minnesota.
ASAIO J. 2018 Nov/Dec;64(6):735-740. doi: 10.1097/MAT.0000000000000710.
Infection is a serious complication of left ventricular assist device (LVAD) therapy. However, an optimal antimicrobial surgical infection prophylaxis (SIP) regimen for LVAD implantation is not well established. We retrospectively reviewed all adults who underwent continuous-flow LVAD implantation from February 2007 to March 2015 at Mayo Clinic Rochester. Left ventricular assist device infection (LVADI) was defined using criteria published by the International Society for Heart and Lung Transplant. Patients excluded from the analysis included those who did not have HeartMate II or HeartWare device, patients with incomplete documentation of SIP, and those with an actively treated infection at the time of LVAD implantation. We compared risk of LVAD-specific and LVAD-related infections and all-cause mortality between SIP regimens at postoperative day 90 and 1 year using Kaplan-Meier time-to-event analyses. During study period, 239 adults underwent continuous-flow LVAD implantation at our institution where 199 patients received single-drug and 40 received multidrug SIP regimen. Median patient age was 62 years. Left ventricular assist device infection occurred in three patients (1.5%) in the single-drug group versus two patients (5.0%) in the multidrug group at 90 days (p = 0.4). There was no difference in infection-free (p = 0.4) and overall survival (p = 0.9) between two groups at 1 year. In conclusion, there was no clear benefit of using multidrug regimen as it did not impact infection-free survival or all-cause mortality compared with single-drug regimen. Prospective clinical trials are needed to further define the optimal SIP regimen for LVAD implantation.
感染是左心室辅助装置（LVAD）治疗的严重并发症。然而，LVAD 植入术的最佳抗菌手术感染预防（SIP）方案尚未确定。我们回顾性分析了 2007 年 2 月至 2015 年 3 月在梅奥诊所罗彻斯特分校接受连续血流 LVAD 植入术的所有成年人。LVAD 感染（LVADI）的定义采用国际心肺移植协会公布的标准。分析中排除了未接受 HeartMate II 或 HeartWare 装置的患者、SIP 记录不完整的患者以及 LVAD 植入时正在积极治疗感染的患者。我们比较了术后第 90 天和 1 年时 90 天和 1 年的 SIP 方案之间 LVAD 特异性和 LVAD 相关感染以及全因死亡率的风险，使用 Kaplan-Meier 时间事件分析。在研究期间，我们机构对 239 名成年人进行了连续血流 LVAD 植入，其中 199 名患者接受了单药 SIP 方案，40 名患者接受了多药 SIP 方案。患者中位年龄为 62 岁。单药组有 3 名患者（1.5%）和多药组有 2 名患者（5.0%）在 90 天内发生感染（p=0.4）。两组在 1 年时的感染无差异（p=0.4）和总生存率（p=0.9）。总之，与单药方案相比，多药方案并未改善感染无生存率或全因死亡率，因此没有明显优势。需要进行前瞻性临床试验以进一步确定 LVAD 植入术的最佳 SIP 方案。
