Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
Department of Statistics, University of Granada, Granada, Spain.
Artif Organs. 2019 Jul;43(7):E124-E138. doi: 10.1111/aor.13441. Epub 2019 Mar 22.
Infection remains the Achilles heel of left ventricular assist device (LVAD) therapy. However, an optimal antimicrobial surgical infection prophylaxis (SIP) regimen has not been established. This study evaluated the efficacy of a single-drug SIP compared to a multi-drug SIP on clinical outcomes in patients undergoing continuous-flow LVAD (CF-LVAD) and pulsatile LVAD (P-LVAD) implantation. An electronic search was performed to identify studies in the English literature on SIP regimens in patients undergoing LVAD implantation. Identified articles were assessed for inclusion and exclusion criteria. Fourteen articles with 1,311 (CF-LVAD: 888; P-LVAD: 423) patients were analyzed. Overall, 501 (38.0%) patients received single-drug SIP, whereas 810 (62.0%) received multi-drug SIP. Time to infection was comparable between groups. There was no significant difference in overall incidence of LVAD-specific infections [single-drug: 18.7% vs. multi-drug: 24.8%, P = 0.49] including driveline infections [single-drug: 14.1% vs. multi-drug: 20.8%, P = 0.37]. Compared to single-drug SIP, patients who received multi-drug SIP had a significantly lower survival rate [single-drug: 90.0% vs. multi-drug: 76.0%, P = 0.01] and infection-free survival rate [single-drug: 88.4% vs. multi-drug: 77.3%, P = 0.04] at 90 days. However, there were no significant differences in 1-year survival and 1-year infection-free survival between groups. No survival differences were observed in the CF-LVAD subset as well. This study demonstrated no additional advantage of a multi-drug compared to a single-drug regimen for SIP. Although there was a modest advantage in early survival among CF-LVAD and P-LVAD patients who received single-drug SIP, there were no significant differences in the 1-year survival and 1-year infection-free survival.
感染仍然是左心室辅助装置（LVAD）治疗的阿喀琉斯之踵。然而，尚未建立最佳的抗微生物手术感染预防（SIP）方案。本研究评估了与多药物 SIP 相比，单一药物 SIP 对接受连续流 LVAD（CF-LVAD）和搏动性 LVAD（P-LVAD）植入患者的临床结局的疗效。进行了电子搜索，以确定关于 LVAD 植入患者 SIP 方案的英文文献中的研究。评估了确定的文章是否符合纳入和排除标准。分析了 14 篇文章，共 1311 例患者（CF-LVAD：888 例；P-LVAD：423 例）。总体而言，501 例（38.0%）患者接受了单一药物 SIP，而 810 例（62.0%）患者接受了多药物 SIP。两组之间的感染时间无显著差异。LVAD 特定感染的总发生率无显著差异[单一药物：18.7%vs.多药物：24.8%，P=0.49]，包括导线感染[单一药物：14.1%vs.多药物：20.8%，P=0.37]。与单一药物 SIP 相比，接受多药物 SIP 的患者生存率显著降低[单一药物：90.0%vs.多药物：76.0%，P=0.01]，感染无生存率也显著降低[单一药物：88.4%vs.多药物：77.3%，P=0.04]在 90 天。然而，两组之间在 1 年生存率和 1 年无感染生存率方面无显著差异。CF-LVAD 亚组也未观察到生存差异。本研究表明，与单一药物方案相比，多药物方案在 SIP 方面没有额外的优势。尽管接受单一药物 SIP 的 CF-LVAD 和 P-LVAD 患者的早期生存率略有优势，但在 1 年生存率和 1 年无感染生存率方面无显著差异。
