183. Comparison of Peri-Operative Antimicrobial Prophylaxis Regimens in Patients Receiving Ventricular Assist Devices
Session: Poster Abstract Session: Catheter-associated BSIs
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Wungwattana_VADSSIs_IDSA2013.pdf (478.2 kB)
  • Background: Ventricular assist devices (VADs) are an advanced treatment option for patients with end stage heart failure.  VAD implantation carries significant infectious risks such as driveline and pocket infections, mediastinitis, and endocarditis. Additionally, there are risks for secondary infections such as bacteremias, pneumonias, and urinary tract infections. Various prophylactic antibiotic regimens have been described among centers with VAD implantation. However, there currently is no consensus antimicrobial prophylaxis regimen for VAD implantation procedures. We aimed to retrospectively compare the clinical outcomes between two prophylaxis regimens utilized at our center.

    Methods: A total of 117 patients were identified by a database of VAD recipients at our center. Eighty-seven patients were divided into two treatment cohorts: recipients of multi-drug (n=31) or a two-drug regimen (n=56). The primary outcome was comparison of surgical site infection rates between two prophylactic regimens.  The following infection-related parameters were compared: infection rates, site of infection, cultured organisms, and overall mortality.  This study is IRB approved.

    Results: No statistical differences were seen between the two cohorts for overall infection rates (46.4% two-drug vs. 38.7% multi-drug, p = 0.484), surgical site infection rates (8.5% two-drug vs. 18.6% multi-drug, p = 0.085), or fungal infection rates (2.8% two-drug vs. 3.6% multi-drug, p = 0.840).  Sub-analysis of infections did show statistical difference for urinary tract infection rates (38% two-drug vs. 20% multi-drug, p = 0.029) and gastrointestinal tract infection rates (1.4% two-drug vs. 11.9% multi-drug, p = 0.014).

    Conclusion: A prophylaxis regimen consisting of a two-drug versus a multi-drug regimen did not result in an increase in surgical site and overall rates of infection.  Despite the removal of fluconazole, there was also no difference in fungal infections observed.  Further analysis between the two treatment cohorts is warranted to determine whether the infections contracted, despite the higher incidence, are more amenable to treatment.  Based on the results of our study, a two-drug prophylaxis regimen resulted in similar rates of infections when compared to a multi-drug prophylaxis regimen for VAD implantation.

    Minkey Wungwattana, Pharm.D.1, Thomas C. Wozniak, M.D.2, Matthew F. Wack, M.D.3, David W. Smith, Pharm.D., B.C.P.S. AQ-ID1, Michael J. Latran, Pharm.D.1, Kevin Chen, B.S.2, Elizabeth M. Amerman, B.S.N., R.N.4, Tracie L. Layne, M.S.N., R.N., C.C.R.N.4, Courtney A. Sheehan, Pharm.D., B.C.P.S.1 and I-Wen Wang, M.D., Ph.D.2, (1)Pharmacy, Indiana University Health, Indianapolis, IN, (2)IU Health Cardiovascular Surgeons, Indiana University Health, Indianapolis, IN, (3)Infectious Diseases of Indianapolis, Indianapolis, IN, (4)IU Health VAD and ECMO Coordinators, Indiana University Health, Indianapolis, IN

    Disclosures:

    M. Wungwattana, None

    T. C. Wozniak, None

    M. F. Wack, None

    D. W. Smith, None

    M. J. Latran, None

    K. Chen, None

    E. M. Amerman, None

    T. L. Layne, None

    C. A. Sheehan, None

    I. W. Wang, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.