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Driveline Infections Incidence According to Dressing Methods for Patients with Left Ventricular Assist Device Implantation

좌심실보조장치 수술 환자의 드레싱 방법에 따른 드라이브라인 감염 실태

  • Choi, Nam Gyung (Department of Nursing, Samsung Medical Center) ;
  • Choi, Su Jung (Graduate School of Clinical Nursing Science, Sungkyunkwan University) ;
  • Choi, Ji Yeon (Department of Nursing, Samsung Medical Center) ;
  • Park, Sun Hee (Department of Nursing, Samsung Medical Center)
  • Received : 2022.05.31
  • Accepted : 2022.06.24
  • Published : 2022.08.31

Abstract

Purpose: Driveline infection (DLI) is one of the major adverse events of Left Ventricular Assist Device (LVAD). The purpose of this study was to explore the incidence of DLI according to the driveline dressing methods. Methods: This study was a retrospective cohort study that investigated the medical records of 75 patients who implanted LVAD from January 2015 to December 2020 at a hospital in Seoul, Korea. Traditionally, sandwich dressing method was applied until October 2019, after which newly winded dressing method was adopted for driveline dressing to LVAD patients. The outcome variables were compared between sandwich dressing method applied group (n=41) and winded dressing method applied group (n=34). The follow-up period for DLI was 1 year. Results: When compared participants' characteristics, there was no difference between the two groups, except the type of LVAD device. The incidence of DLI was 17.1% in sandwich dressing group, while no infection was found in winded dressing group (p=.011). Conclusion: Although there were difference in the LVAD devices, it is considered that winded dressing contributed to the reduction of DLI. Further research on standardized dressing methods was required for DLI prevention in Korea.

Keywords

References

  1. Potapov EV, Antonides C, Crespo-Leiro MG, Combes A, Farber G, Hannan MM, et al. 2019 EACTS expert consensus on long-term mechanical circulatory support. European Journal of Cardio-Thoracic Surgery. 2019;56(2):230-270. https://doi.org/10.1093/ejcts/ezz098
  2. Bernhardt AM, Schloglhofer T, Lauenroth V, Mueller F, Mueller M, Schoede A, et al. Prevention and early treatment of driveline infections in ventricular assist device patients -The DESTINE staging proposal and the first standard of care protocol. Journal of Critical Care. 2020;56:106-112. https://doi.org/10.1016/j.jcrc.2019.12.014
  3. Molina EJ, Shah P, Kiernan MS, Cornwell WK 3rd, Copeland H, Takeda K, et al. The Society of Thoracic Surgeons Intermacs 2020 annual report. Annals of Thoracic Surgery. 2021;111(3):778-792. https://doi.org/10.1016/j.athoracsur.2020.12.038
  4. Lee JH, Park IK, Lee HM, Sung KI, Lee YT, Kim DR, et al. Use of durable left ventricular assist devices for high-risk patients: Korean experience before insurance coverage. Journal of Thoracic Disease. 2020;12(12):7236-7244. https://doi.org/10.21037/jtd-20-1429
  5. Kormos RL, Antonides CF, Goldstein DJ, Cowger JA, Starling RC, Kirklin JK, et al. Updated definitions of adverse events for trials and registries of mechanical circulatory support: A consensus statement of the mechanical circulatory support academic research consortium. Journal of Heart and Lung Transplantation. 2020;39(8):735-750. https://doi.org/10.1016/j.healun.2020.03.010
  6. Hannan MM, Xie R, Cowger J, Schueler S, de By T, Dipchand AI, et al. Epidemiology of infection in mechanical circulatory support: A global analysis from the ISHLT mechanically assisted circulatory support registry. Journal of Heart and Lung Transplantation. 2019;38(4):364-373. https://doi.org/10.1016/j.healun.2019.01.007
  7. Kusne S, Mooney M, Danziger-Isakov L, Kaan A, Lund LH, Lyster H, et al. An ISHLT consensus document for prevention and management strategies for mechanical circulatory support infection. Journal of Heart and Lung Transplantation. 2017;36(10):1137-1153. https://doi.org/10.1016/j.healun.2017.06.007
  8. Juraszek A, Smolski M, Kolsut P, Szymanski J, Litwinski P, Kusmierski K, et al. Prevalence and management of driveline infections in mechanical circulatory support - A single center analysis. Journal of Cardiothoracic Surgery. 2021;16(1):216. https://doi.org/10.1186/s13019-021-01589-6
  9. Casida JM, Aikens JE, Craddock H, Aldrich MW, Pagani FD. Development and feasibility of self-management application in left-ventricular assist devices. ASAIO Journal. 2018;64(2):159-167. https://doi.org/10.1097/mat.0000000000000673
  10. Leuck AM. Left ventricular assist device driveline infections: Recent advances and future goals. Journal of Thoracic Disease. 2015;7(12):2151-2157. https://doi.org/10.3978/j.issn.2072-1439.2015.11.06
  11. Aburjania N, Hay CM, Sohail MR. Continuous-flow left ventricular assist device systems infections: Current outcomes and management strategies. Annals of Cardiothoracic Surgery. 2021;10(2):233-239. https://doi.org/10.21037/acs-2020-cfmcs-26
  12. Stahovich M, Sundareswaran KS, Fox S, Hallinan W, Blood P, Chen L, et al. Reduce driveline trauma through stabilization and exit site management: 30 days feasibility results from the multicenter RESIST study. ASAIO Journal. 2016;62(3):240-245. https://doi.org/10.1097/mat.0000000000000374
  13. Goldstein DJ, Naftel D, Holman W, Bellumkonda L, Pamboukian SV, Pagani FD, et al. Continuous-flow devices and percutaneous site infections: Clinical outcomes. Journal of Heart and Lung Transplantation. 2012;31(11):1151-1157. https://doi.org/10.1016/j.healun.2012.05.004
  14. Pavlovic NV, Randell T, Madeira T, Hsu S, Zinoviev R, Abshire M. Risk of left ventricular assist device driveline infection: A systematic literature review. Heart and Lung. 2019;48(2):90-104. https://doi.org/10.1016/j.hrtlng.2018.11.002
  15. Nurjadi D, Last K, Klein S, Boutin S, Schmack B, Mueller F, et al. Nasal colonization with Staphylococcus aureus is a risk factor for ventricular assist device infection in the first year after implantation: A prospective, single-centre, cohort study. Journal of Infection. 2020;80(5):511-518. https://doi.org/10.1016/j.jinf.2020.02.015
  16. Hwang TY, Kim MG, Oh SW, Jo SK, Cho WY, Yang JH. Pathogens of peritoneal dialysis peritonitis: Trends from a single-center experience over 15 years. Kidney Research and Clinical Practice. 2020;39(2):221-227. https://doi.org/10.23876/j.krcp.19.035
  17. Koken ZO, Yalcin YC, van Netten D, de Bakker CC, van der Graaf M, Kervan U, et al. Driveline exit-site care protocols in patients with left ventricular assist devices: A systematic review. European Journal of Cardio-Thoracic Surgery. 2021;60(3):506-515. https://doi.org/10.1093/ejcts/ezab195
  18. Aslam S, Dan J, Topik A, Belyk M, Torriani F, Taplitz R, et al. Decrease in driveline infections with change in driveline management protocol. VAD Journal. 2016;2:13. https://doi.org/10.13023/VAD.2016.03
  19. Lander MM, Kunz N, Dunn E, Althouse AD, Lockard K, Shullo MA, et al. Substantial reduction in driveline infection rates with the modification of driveline dressing protocol. Journal of Cardiac Failure. 2018;24(11):746-752. https://doi.org/10.1016/j.cardfail.2018.07.464
  20. Cagliostro B, Levin AP, Fried J, Stewart S, Parkis G, Mody KP, et al. Continuous-flow left ventricular assist devices and usefulness of a standardized strategy to reduce drive-line infections. Journal of Heart and Lung Transplantation. 2016;35(1):108-114. https://doi.org/10.1016/j.healun.2015.06.010
  21. Snydman DR, Kusne S, Staley L, Arabia F. Prevention and infection management in mechanical circulatory support devices recipients. Clinical Infectious Diseases. 2017;64(2):222-228. https://doi.org/10.1093/cid/ciw698
  22. Son AY, Stein LH, DeAnda A, Katz SD, Smith DE, Reyentovich A, et al. Impact of chlorhexidine gluconate intolerance on driveline infection during chronic HeartMate II left ventricular assist device support. International Journal of Artificial Organs. 2017;39(11):570-574. https://doi.org/10.5301/ijao.5000539
  23. Forest SJ, Bello R, Friedmann P, Casazza D, Nucci C, Shin JJ, et al. Readmissions after ventricular assist device: Etiologies, patterns, and days out of hospital. Annals of Thoracic Surgery. 2013;95(4):1276-1281. https://doi.org/10.1016/j.athoracsur.2012.12.039
  24. Mourad A, Arif S, Bishawi M, Milano C, Miller RA, Maskarinec SA. Surgical infection prophylaxis prior to left ventricular assist device implantation: A survey of clinical practice. Journal of Cardiac Surgery. 2020;35(10):2672-2678. https://doi.org/10.1111/jocs.14882
  25. Zierer A, Melby SJ, Voeller RK, Guthrie TJ, Ewald GA, Shelton K, et al. Late-onset driveline infections: The Achilles' heel of prolonged left ventricular assist device support. Annals of Thoracic Surgery. 2007;84(2):515-520. https://doi.org/10.1016/j.athoracsur.2007.03.085
  26. Johnson M, Gilardi S, Cobb T, Miller J, Varick L, Smith T, et al. Change in caregiver increases risk for driveline infection. Journal of Heart and Lung Transplantation. 2021;40(4 Suppl):S459. https://doi.org/10.1016/j.healun.2021.01.1275
  27. Aburjania N, Sherazi S, Tchantchaleishvili V, Alexis JD, Hay CM. Stopping conventional showering decreases Pseudomonas infections in left ventricular assist device patients. International Journal of Artificial Organs. 2017;40(6):282-285. https://doi.org/10.5301/ijao.5000590
  28. Wilcox JE, Cameron KA, Harap RS, Shanklin KL, Grady KL, Cohen ER, et al. Ventricular assist device driveline dressing-change protocols: A need for standardization. A Report from the SimVAD Investigators. Journal of Cardiac Failure. 2019;25(8):695-697. https://doi.org/10.1016/j.cardfail.2019.06.009
  29. Baronetto A, Centofanti P, Attisani M, Ricci D, Mussa B, Devotini R, et al. A simple device to secure ventricular assist device driveline and prevent exit-site infection. Interactive CardioVascular and Thoracic Surgery. 2014;18(4):415-417. https://doi.org/10.1093/icvts/ivt549