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Expanding Use of New Technology Creates New Challenges in Preventing and Managing Infections: a Review of Diagnostic and Management Considerations for Infections Among Patients with Long-Term Invasive Devices for Advanced Heart Failure

  • Healthcare Associated Infections (G Bearman and D Morgan, Section Editors)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Purpose of the Review

Although still a relatively new technology, long-term left ventricular assist devices (LVADs) for management of advanced heart failure is rapidly increasing. Initially designed as a bridge to transplant, these invasive devices are increasingly used as a destination therapy, creating unique and long-term infection risks. The aim of this comprehensive review is to highlight current evidence about the prevention, diagnosis, and management of LVAD-specific infections.

Recent Findings

There are two recent, major societal guidelines (The International Society for Heart and Lung Transplantation, 2017, and the American Society of Transplantation, 2019) specifically on the diagnosis and management of infections in LVAD patients. A third guideline from the European Association for Cardio-Thoracic Surgery (2019) on general LVAD management contains a section on infection management. Recommendations tend to be concordant across the guidelines without major disagreements and suggest that for superficial infections, limited-course durations of antimicrobials are acceptable. For infections of deeper portions of the device, long-term antimicrobial regimens, often with chronic suppressive strategies remain the mainstay of treatment; however, this recommendation is based primarily on expert opinion as high-quality evidence to support best practices remains limited. The role of surgical management remains unknown.

Summary

Management of long-term, device-related infections in patients with advanced heart failure is challenging and should include input from a multi-disciplinary team of providers to determine the best management strategy. A strong emphasis on best prevention practices is a necessity. With this relatively new technology, evidence-based data to guide best practices remains limited and is an important area of future research.

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Abbreviations

VAD:

Ventricular assist device

LVADs:

Left ventricular assist devices

MCS:

Mechanical circulatory support

BTT:

Bridge to transplant

DT:

Destination therapy

CF-LVAD:

Continuous-flow left ventricular assist device

DLI:

Driveline infection

AST:

American Society of Transplantation

ISHLT:

International Society for Heart and Lung Transplantation

EACTS:

European Association for Cardio-Thoracic Surgery

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Acknowledgements

The authors would like to acknowledge Diane E. Young, MLS and Megan C. McNichol, MLS, AHIP from the Beth Israel Deaconess Medical Center Information Systems/Knowledge Services for her assistance in the literature review.

Diane E. Young, MLS, Information Specialist

Information Systems - Knowledge Services

Beth Israel Deaconess Medical Center

Boston, MA 02215

Megan C. McNichol, MLS, AHIP|Manager

Information Systems – Knowledge Services

Beth Israel Deaconess Medical Center

Boston, MA 02215

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Authors and Affiliations

  1. Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street – Suite GB, Boston, MA, 02215, USA

    Matthew S. L. Lee

  2. Harvard Medical School, Boston, MA, USA

    Matthew S. L. Lee & Westyn Branch-Elliman

  3. Division of Cardiology - Section of Advanced Heart Failure and Transplantation, University of Colorado Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, USA

    Natasha L. Altman

  4. Department of Medicine, VA Boston Healthcare System, Harvard Medical School, 1400West Roxbury, Boston, MA, 02132, USA

    Westyn Branch-Elliman

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Matthew S.L. Lee, MD, and Natasha L. Altman, MD, declare no conflict of interest.

Westyn Branch-Elliman, MD, MMSc, declare no conflict of interest. Salary is supported by grant NHLBI 1K12HL138049-01.

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Lee, M.S.L., Altman, N.L. & Branch-Elliman, W. Expanding Use of New Technology Creates New Challenges in Preventing and Managing Infections: a Review of Diagnostic and Management Considerations for Infections Among Patients with Long-Term Invasive Devices for Advanced Heart Failure. Curr Infect Dis Rep 22, 16 (2020). https://doi.org/10.1007/s11908-020-00724-z

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