The Impact of Preoperative Antimicrobial Prophylaxis on Device-Related Infections in Recipients of Long-Term Mechanical Circulatory Support (MCS)
1Eastern Virginia Medical School, Norfolk, VA
2Sentara Norfolk General Hospital, Norfolk, VA.
Meeting: 2015 American Transplant Congress
Abstract number: C179
Keywords: Infection, Prophylaxis
Session Information
Session Name: Poster Session C: "Loss of Breath": VADs and Other Pre-Heart Transplant Matters
Session Type: Poster Session
Date: Monday, May 4, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Purpose: Although preoperative antimicrobial prophylaxis is recommended for patients undergoing long-term MCS device implantation, there is a lack of consensus as to the optimal preoperative antibiotic regimen, criteria for discontinuation and management of colonization. As with most MCS programs, our center recently expanded antimicrobial prophylaxis to include 2 or 3 antibiotics and an antifungal agent. We investigated the impact of these changes on development of MCS-related infections.
Methods: We studied 98 consecutive recipients of de novo long-term MCS devices at our center beteween 1/2010 and 11/2012 (94 HeartMate II LVAD, 2 HeartWare and 2 total artificial heart; 72% BTT and 27.8% DT; 73.5% male; 53% African American ethnicity; mean age 54.9±13 years; 49.5% non-ischemic cardiomyopathy). Device-related infections were defined using the recently published ISHLT criteria. Patients were followed until transplant, pump exchange, death or day of last observation on April 30, 2013. Mean follow-up was 13.7 months (range:14 days to 3.2 years).
Results: Preoperative antimicrobial prophylaxis was given to 98% of study patients (49% of patients received one-, 8% two- and 41% three-antibiotic regimen). Antifungal agents were added in 40% of patients. In addition, 29% of patients prior to surgery and 93% after surgery were treated with antibiotics for other conditions. Overall, 33 (34%) of patients developed device-related infection (17.1%, 24.7%, 52.7% and 57.4% at 0.5-,1-,2- and 3-years of support). By multivariate analysis, the only independent predictors of MCS-related infection included ≥2 reoperations prior to chest closure (RR 4.0, p<0.01) and postimplant outpatient medical noncompliance (RR 3.1, p=0.07). None of the preoperative antibiotic regimens (one-,two- or three-antibiotic regimen), specific antibiotics used (vancomycin, cefazolin, cefepime) or antifungal agent was found to be an independent predictor in preventing device-related infections.
Conclusion: Device-related infection developed in more than half of the long-term MCS recipients at our center by 3 years post implant. None of the preoperative antibiotic regimens or specific antibiotics used were found to be superior in preventing this complication. Further studies are needed to define appropriate perioperative antibiotic regimens.
To cite this abstract in AMA style:
Lakkis IEl, Lietz K, Derber C, Kelly U, Wilson C, Hoedt A, Bourasssa P, Smith B, McGrath M, Herre J, Mooney M. The Impact of Preoperative Antimicrobial Prophylaxis on Device-Related Infections in Recipients of Long-Term Mechanical Circulatory Support (MCS) [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/the-impact-of-preoperative-antimicrobial-prophylaxis-on-device-related-infections-in-recipients-of-long-term-mechanical-circulatory-support-mcs/. Accessed June 2, 2025.« Back to 2015 American Transplant Congress