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. 2022 Jan;41(1):1-16.
doi: 10.1016/j.healun.2021.10.006. Epub 2021 Oct 22.

Non-patient factors associated with infections in LVAD recipients: A scoping review

Supriya Shore  1 , Michael J Pienta  2 , Tessa M F Watt  2 , Gardner Yost  2 , Whitney A Townsend  3 , Lourdes Cabrera  2 , Michael D Fetters  4 , Carol Chenoweth  5 , Keith D Aaronson  6 , Francis D Pagani  2 , Donald S Likosky  2 ; Michigan Congestive Heart Failure Investigators
Affiliations

Non-patient factors associated with infections in LVAD recipients: A scoping review

Supriya Shore et al. J Heart Lung Transplant. 2022 Jan.

Abstract

Background: Infections are the most common complication in recipients of durable left ventricular assist devices (LVAD) and are associated with increased morbidity, mortality, and expenditures. The existing literature examining factors associated with infection in LVAD recipients is limited and principally comprises single-center studies. This scoping review synthesizes all available evidence related to identifying modifiable, non-patient factors associated with infections among LVAD recipients.

Methods: Published studies were identified through searching 5 bibliographic databases: PubMed, Scopus, EMBASE, CINAHL, and Web of Science Core Collection. Inclusion criteria required examination of factors associated with infections among recipients of contemporary, implantable, continuous flow LVADs. Key study characteristics were extracted by 4 independent reviewers and current literature described narratively. The Systems Engineering Initiative for Patient Safety (SEIPS) model was used to develop a taxonomy for non-patient related factors (e.g., tasks, tools, technologies, organization, and environment) associated with infections following LVAD implantation. All analyses took place between February 2019 and May 2021.

Findings: A total of 43 studies met inclusion criteria. The majority of included studies were observational (n = 37), single-center (n = 29), from the U.S. (n = 38), and focused on driveline infections (n = 40). Among the 22 evaluated sub-domains of non-patient related factors, only two: increasing center experience and establishing a silicone-skin interface at the driveline exit site, were identified as consistently being associated with a lower risk of infection.

Conclusion: This review identified 43 studies that described non-patient related factors associated with infection in LVAD recipients. Only two factors were consistently associated with lower infection risk in LVAD recipients: increasing experience and establishing a silicone-skin interface at driveline exit site. The large variability in reporting across multiple studied interventions limited the ability to discern their effectiveness.

Keywords: LVAD; driveline infection; infection; infection prevention; surgical techniques, antibiotic prophylaxis.

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Conflict of interest statement

Conflict of interest statement Supriya Shore is supported by American Heart Association Career Development Award (ID 855105).Donald S. Likosky receives: (i) extramural support from the Agency for Healthcare Research and Quality and National Institutes of Health; (ii) partial salary support from Blue Cross Blue Shield of Michigan; and (iii) support as a consultant to the American Society of ExtraCorporeal Technology. Keith Aaronson serves on a Medtronic Independent Physician Quality Panel. Francis D. Pagani is a member of the scientific advisory board of FineHeart, Inc., member of the Data Safety Monitoring Board for Carmat, Inc., member of the Data Safety Monitoring Board for the National Heart, Blood, and Lung Institute PumpKIN clinical trial, and Chair of The Society of Thoracic Surgeons, INTERMACS Task Force.

Figures

Figure 1:
Figure 1:
Flowchart for study selection
Figure 2:
Figure 2:
Heat Map of Studied Infections and Associated Factors in left ventricular assist device recipients stratified by SEIPS category Legend: C diff: Clostridium difficile; HMII: HeartMate 2; LVAD: left ventricular assist device
Figure 2:
Figure 2:
Heat Map of Studied Infections and Associated Factors in left ventricular assist device recipients stratified by SEIPS category Legend: C diff: Clostridium difficile; HMII: HeartMate 2; LVAD: left ventricular assist device
Figure 2:
Figure 2:
Heat Map of Studied Infections and Associated Factors in left ventricular assist device recipients stratified by SEIPS category Legend: C diff: Clostridium difficile; HMII: HeartMate 2; LVAD: left ventricular assist device
Figure 2:
Figure 2:
Heat Map of Studied Infections and Associated Factors in left ventricular assist device recipients stratified by SEIPS category Legend: C diff: Clostridium difficile; HMII: HeartMate 2; LVAD: left ventricular assist device
Figure 2:
Figure 2:
Heat Map of Studied Infections and Associated Factors in left ventricular assist device recipients stratified by SEIPS category Legend: C diff: Clostridium difficile; HMII: HeartMate 2; LVAD: left ventricular assist device
See this image and copyright information in PMC

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