303. Prolonged Antibiotic Prophylaxis after Left Ventricular-Assist Device (LVAD) Implantation is Associated with Increased Antibacterial Resistance
Session: Poster Abstract Session: HAI: Device Associated Infections
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • LVAD poster.pdf (1.6 MB)
  • Background: In heart failure patients with LVADs, infection is associated with significant morbidity and frequent hospitalizations. The effects of prolonged antibiotic prophylaxis after LVAD implantation on the incidence of LVAD-associated infections and antibacterial resistance have not been adequately described.

    Methods: We retrospectively studied patients with continuous flow LVADs placed at Brigham and Women's Hospital (BWH) and Massachusetts General Hospital (MGH), between 1/1/2007 and 11/30/2014. We compared two different strategies after implantation: 1. sterile dressing with chlorhexidine skin cleanser (BWH) and 2. oral doxycycline with topical polymyxin/trimethoprim drops (MGH). We captured LVAD-specific or related infections, and analyzed pathogen susceptibilities during first episodes of infection.

    Results: More patients in the prophylaxis group had received an LVAD as bridge to transplant and had a HeartWare HVAD device. There were no differences in institutional antibiogram rates of susceptibility to tetracycline or trimethoprim/sulfamethoxazole (TMP/SMX). Male sex and diabetes (DM), but not antibiotic prophylaxis, were independent predictors of LVAD infection, after adjustment for death or transplant as competing events. Prophylaxis was associated with increased rates of resistance to tetracycline and TMP/SMX (Figure, Table).

    Conclusion: Antibiotic prophylaxis after LVAD implantation was not associated with decreased rates of LVAD infection, but with increased rates of antibacterial resistance, potentially limiting oral treatment options for established infection.

    N (%) unless otherwise indicated

    Antibiotic prophylaxis

    (N=60)

    No antibiotic prophylaxis

    (N=131)

    Age (yrs, meanSD)

    5511

    5512

    Men

    54 (90)

    105 (80)

    Patient-days of VAD support (meanSD)

    359299

    495486

    Destination VAD*

    9 (15)

    51 (39)

    HeartWare HVAD**

    22 (37)

    14 (11)

    DM

    11 (18)

    24 (18)

    VAD infection

    First

    59

    30

    All

    71

    39

    Bacteremia

    First

    9

    15

    All

    24

    17

    Tetracycline susceptibility**

    All isolates

    1/22 (5)

    19/33 (58)

    Staphylococcus spp.

    1/9 (11)

    16/19 (84)

    TMP/SMX susceptibility

    All isolates*

    4/22 (14)

    15/34 (44)

    Staphylococcus spp.

    3/9 (33)

    12/19 (63)

    Episodes per 100 patient-yrs of VAD support; P value: *<.05, **<.001

    Figure JPEG.jpg

    Dimitrios Farmakiotis, MD1, Alyssa R. Letourneau, MD, MPH2, Alicia Galar, PharmD, PhD1, Sophia Koo, MD1, James Maguire, MD1, Michael M. Givertz, MD3 and Lindsey R. Baden, MD4, (1)Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, (2)Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, (3)Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, (4)Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA

    Disclosures:

    D. Farmakiotis, None

    A. R. Letourneau, None

    A. Galar, None

    S. Koo, None

    J. Maguire, None

    M. M. Givertz, None

    L. R. Baden, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.