Single vs. Multi-Drug Antibiotic Prophylaxis for Continuous-Flow Left Ventricular Assist Device Implantation: A Systematic Review and Meta-Analysis
1Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA
2University of Granada, Granada, Spain
3University of Alberta, Edmonton, AB, Canada
4Division of Infectious Diseases, Thomas Jefferson University, Philadelphia, PA.
Meeting: 2018 American Transplant Congress
Abstract number: B36
Keywords: Infection, Prophylaxis, Surgical complications, Ventricular assist devices
Session Information
Session Name: Poster Session B: Heart and VADs: All Topics
Session Type: Poster Session
Date: Sunday, June 3, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Purpose: Despite the fact that infection remains a major complication of continuous-flow left ventricular assist device (CF-LVAD) therapy, an optimal antimicrobial surgical infection prophylaxis (SIP) regimen has not been established. The purpose of this study was to evaluate the efficacy of single- (SD) and multi-drug (MD) SIP regimens on clinical outcomes in CF-LVAD patients, including device-related infections.
Methods: Electronic search was performed to identify all studies reporting SD and MD SIP regimen in patients undergoing CF-LVAD implantation. Identified articles were assessed for inclusion and exclusion criteria, and pooled for systematic review and meta-analysis.
Results: Total of six articles with 883 patients were pooled for the analysis. Of these, 358 (41%) patients received SD while 525 (59%) patients received MD prophylaxis. Mean age of patients at implantation was 55 years and 20% were female. Average follow up time post LVAD implantation were comparable between the two groups [MD: 12 months (95% CI 0-27 months); SD: 9 months (95% CI 0-26 months), p=0.99]. Average time to infection following CF-LVAD implantation was 14 months (95% CI 0-140 months) in the MD group, and 4 months (95% CI 0-172 months) in the SD group (p=0.99). No significant difference was found in the number of LVAD device-specific infections [MD: 17% (95% CI 10%-28%); SD: 9% (95% CI 4%-20%), p=0.20], driveline infections [MD 15% (95% CI 10%-23%); SD 7% (95% CI 3%-17%), p=0.12] and pump-pocket infections [MD: 3% (95% CI 1%-8%); SD: 2% (95% CI 1%-6%), p=0.51] between the two groups. Overall survival following CF-LVAD implantation were comparable between the two groups at 90 days [SD: 90% (95% CI 85%-93%); MD: 82% (95% CI 76%-92%), p=0.27] and 1 year [SD: 78% (95% CI 72%-84%); MD: 64% (95% CI 12%-96%), p=0.6].
Conclusion: Our analysis showed no clear advantage to use a MD regimen over a SD regimen in surgical infection prophylaxis. Furthermore, there were no significant differences in the frequency of LVAD device infections and post LVAD implantation survival.
CITATION INFORMATION: Patel S., Choi J., Moncho Escrivà E., Rizvi S., Samuels L., Luc J., Morris R., Massey H., Tchantchaleishvili V., Aburjania N. Single vs. Multi-Drug Antibiotic Prophylaxis for Continuous-Flow Left Ventricular Assist Device Implantation: A Systematic Review and Meta-Analysis Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Patel S, Choi J, Escrivà EMoncho, Rizvi S, Samuels L, Luc J, Morris R, Massey H, Tchantchaleishvili V, Aburjania N. Single vs. Multi-Drug Antibiotic Prophylaxis for Continuous-Flow Left Ventricular Assist Device Implantation: A Systematic Review and Meta-Analysis [abstract]. https://atcmeetingabstracts.com/abstract/single-vs-multi-drug-antibiotic-prophylaxis-for-continuous-flow-left-ventricular-assist-device-implantation-a-systematic-review-and-meta-analysis/. Accessed May 13, 2025.« Back to 2018 American Transplant Congress