Mechanical circulatory support device infection

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