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Impact of antimicrobial selection for prophylaxis of left ventricular assist device surgical infections
Author(s) -
Nguyen Peter T.,
Sam Teena,
Colley Peter,
Zyl Johanna S.,
Felius Joost,
Berhe Mezgebe,
Meyer Dan
Publication year - 2021
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.15682
Subject(s) - medicine , hazard ratio , antimicrobial , cefazolin , confidence interval , antibiotic prophylaxis , proportional hazards model , vancomycin , retrospective cohort study , log rank test , surgery , antibiotics , staphylococcus aureus , microbiology and biotechnology , biology , genetics , bacteria
Background Surgical site infections (SSIs) after left ventricular assist device (LVAD) implantation are associated with high mortality, while surgical prophylaxis is variable. Methods 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‐day and 1‐year postimplantation. Cox‐proportional hazards models and log‐rank tests were used for survival analysis. Results 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 = .290) and 1 year (16.9% vs. 25.6%, p = .435). Comparing narrow to broad prophylaxis, the risk of mortality (hazard ratio [HR] = 0.44, 95% confidence interval [CI] = 0.15–1.35, logrank p = .14), and composite of mortality and infection was reduced (HR = 0.92, 95% CI = 0.45–1.88, logrank p = .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 = .33) by device type. Conclusions 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.