Mechanical circulatory support device infection
From IDWiki
Background
- Includes left ventricular assist device (LVAD) infections
Microbiology
- Coagulase-negative staphylococci
- Staphylococcus aureus
- Enterococcus
- Enterobacteriaceae and Pseudomonas aeruginosa
- Candida
Risk Factors
- Diabetes mellitus
- Obesity
- Chronic kidney disease
- Depression
- Driveline trauma
Clinical Manifestations
- Driveline site infection is the most common with or without other sites of infection, including pocket infection, mediastinitis, pump or cannula infection, endocarditis, and bacteremia
- Driveline site infection will have local signs and symptoms of infection
- Pocket infection will present similarly to CIED pocket infection
- Mediastinitis has fever, chest pain, sternal wound dehiscence or drainage, leukocytosis, and bacteremia
Investigations
- Blood cultures
- Aspirate and culture of any fluid collections
- Ultrasound, CT, or MRI of the chest and abdomen should be considered with bacteremia of unknown source
- Cultures from any removed hardware
Management
- Control control, ideally, with removal of the infected device
- If source control is not possible (which is common), then prolonged antibiotics to suppress infection until heart transplant
