Ventricular Assist Device‐Related Infections And Solid Organ Transplantation

Publication Date: April 1, 2019

Recommendations

DIAGNOSIS

Clinicians must have a heightened suspicion for infection in patients with a VAD, as classic symptoms and signs of infection may be absent. (Low, Strong)
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Imaging, including ultrasound, CT, or echocardiography, may be helpful in identifying infected areas and determining extent of VAD‐specific infection. (Moderate, Strong)
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It is important to obtain cultures of any potentially infected material evident on exam or imaging in order to establish a microbiologic diagnosis with susceptibility testing to target antimicrobial therapy and minimize excessively broad coverage. (Moderate, Strong)
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MANAGEMENT OF INFECTION

In general, VAD infection is not a contraindication to heart transplant, with certain exceptions such as septic shock or mold infection. (Moderate, Strong)
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For superficial driveline infection, short, finite courses of antibiotics may suffice. (Low, Weak)
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However, the specific infecting organism, degree of local inflammation and expected time to transplantation (if patient bridged to transplant) should affect the treatment duration. (Very Low, Strong)
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For VAD‐related bloodstream infections, especially VAD endocarditis, and pump pocket infection, antibiotic therapy should be continued through the time of transplantation or device removal. (Moderate, Strong)
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After explant of the VAD at the time of heart transplant, antimicrobials should be continued in the immediate post‐transplant period, with the length of therapy dependent on the severity of infection.

(Very Low, Strong)
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INFECTION PREVENTION

At the time of VAD implantation, perioperative antibiotic prophylaxis is mandatory with coverage provided at a minimum against staphylococcal species. (Moderate, Strong)
and limited data supporting single agent use compared to broad coverage used in early clinical trials.
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Strict attention to driveline care, including avoiding trauma to the exit site, use of driveline fixation devices, and careful cleaning and dressing changes, is critical for infection prevention. (Low, Strong)
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Recommendation Grading

Disclaimer

Overview

Title

Ventricular Assist Device‐Related Infections And Solid Organ Transplantation

Authoring Organization

Publication Month/Year

April 1, 2019

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

The Infectious Diseases Community of Practice of the American Society of Transplantation has published evidenced‐based guidelines on the prevention and management of infectious complications in SOT recipients since 2004. This updated guideline reviews the epidemiology of ventricular assist device (VAD) infections and provides recommendations for the management and prevention of these infections.

Target Patient Population

Solid organ transplant patients

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Hospital, Operating and recovery room, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Prevention, Management

Diseases/Conditions (MeSH)

D019072 - Antibiotic Prophylaxis, D016470 - Bacteremia, D001424 - Bacterial Infections

Keywords

ventricular assist device, hospital-acquired infection, solid organ transplant, bacteremia

Source Citation

Koval, CE, Stosor, V; on behalf of the AST ID Community of Practice. Ventricular assist device‐related infections and solid organ transplantation—Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019; 33:e13552.