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Impact of Antibiotic Selection for Prophylaxis of Left Ventricular Assist Device Surgical Infections
  • +4
  • Peter Nguyen,
  • Peter Colley,
  • Teena Sam,
  • Johanna Van Zyl,
  • Joost Felius,
  • Mezgebe Berhe,
  • Dan Meyer
Peter Nguyen
Baylor University Medical Center at Dallas
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Peter Colley
Baylor University Medical Center at Dallas
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Teena Sam
Baylor University Medical Center at Dallas
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Johanna Van Zyl
Baylor Scott & White Research Institute
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Joost Felius
Baylor Scott & White Research Institute
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Mezgebe Berhe
Baylor University Medical Center at Dallas
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Dan Meyer
Baylor University Medical Center at Dallas
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Abstract

Surgical site infections (SSI) after left ventricular assist device (LVAD) implantation are associated with high mortality, while surgical prophylaxis is variable. This retrospective study included adult patients who underwent LVAD implantation at a single center. We compared outcomes in patients who received narrow antimicrobial prophylaxis (cefazolin, vancomycin or both) to those who received broad antimicrobial prophylaxis (any antimicrobial combination targeting gram-positive and gram-negative organisms not included in the narrow group) at 30 days and 1 year post-implantation. Cox-proportional hazards models and log-rank tests were used for survival analysis. Among the 39 and 65 patients comprising narrow and broad groups respectively, there was no difference in rate of SSI at 30 days (6.2% vs 12.8%, p = 0.290) and 1 year (16.9% vs 25.6%, p = 0.435). Comparing narrow to broad prophylaxis, the risk of mortality [HR (95% CI): 0.44 (0.15. 1.35), logrank P = 0.14], and composite of mortality and infection was reduced [HR (95% CI): 0.92 (0.45, 1.88), logrank P = 0.83], but did not reach statistical significance. Most culture positive infections were due to gram-positive bacteria (70%) and the most common organisms were the Staphylococcus spp (47%). There were no significant differences in the rate of SSI at 1-year (p=1.00) and mortality (p=0.33) by device type. The rates of infection and all-cause mortality were not different between patients who received narrow or broad prophylaxis. This highlights an opportunity for institutions to narrow their surgical infection prophylaxis protocols to primarily cover gram-positive organisms.

Peer review status:ACCEPTED

31 Jan 2021Submitted to Journal of Cardiac Surgery
03 Feb 2021Submission Checks Completed
03 Feb 2021Assigned to Editor
03 Feb 2021Reviewer(s) Assigned
18 Feb 2021Review(s) Completed, Editorial Evaluation Pending
18 Feb 2021Editorial Decision: Revise Minor
03 Apr 20211st Revision Received
03 Apr 2021Submission Checks Completed
03 Apr 2021Assigned to Editor
03 Apr 2021Reviewer(s) Assigned
03 May 2021Review(s) Completed, Editorial Evaluation Pending
03 May 2021Editorial Decision: Accept