Summary of ISHLT 2017 Recommendations for the Medical and Surgical Management of LVAD Infections [50]
| . | Infection . | Medical Management . | Surgical Management . |
|---|---|---|---|
| LVAD-specific | Superficial DLI | IV/PO antibiotics for 2 weeks or until infection resolves | None |
| Deep DLI/PPI | IV antibiotics for 6–8 weeks or until infection resolves followed by long-term PO suppression | Surgical debridement with or without wound vacuum; new driveline exit site may be required | |
| Pump, cannula, or Bacteremia | IV antibiotics until after heart transplant or an extended course followed by PO suppression (destination therapy); ID consult is advised | Surgical drainage, debridement, or explant may be required; urgent device replacement should be considered in bridge to transplant to prevent end-organ damage that may preclude heart transplant | |
| LVAD-related | Bacteremia | Duration of antibiotics depends on the source, organism, and clearance, at least 2 weeks from first negative blood cultures | |
| Bacterial mediastinitis | Antibiotics for at least 6–8 weeks from last surgical debridement | Surgical debridement is often indicated | |
| Infective endocarditis | Same as for pump and cannula infection | Surgical intervention may be required |
| . | Infection . | Medical Management . | Surgical Management . |
|---|---|---|---|
| LVAD-specific | Superficial DLI | IV/PO antibiotics for 2 weeks or until infection resolves | None |
| Deep DLI/PPI | IV antibiotics for 6–8 weeks or until infection resolves followed by long-term PO suppression | Surgical debridement with or without wound vacuum; new driveline exit site may be required | |
| Pump, cannula, or Bacteremia | IV antibiotics until after heart transplant or an extended course followed by PO suppression (destination therapy); ID consult is advised | Surgical drainage, debridement, or explant may be required; urgent device replacement should be considered in bridge to transplant to prevent end-organ damage that may preclude heart transplant | |
| LVAD-related | Bacteremia | Duration of antibiotics depends on the source, organism, and clearance, at least 2 weeks from first negative blood cultures | |
| Bacterial mediastinitis | Antibiotics for at least 6–8 weeks from last surgical debridement | Surgical debridement is often indicated | |
| Infective endocarditis | Same as for pump and cannula infection | Surgical intervention may be required |
Abbreviations: BSI, bloodstream infection; DLI, driveline infection; ID, infectious disease; IE, infective endocarditis; IV, intravenous; LVAD, left ventricular assist device; PO, oral; PPI, pump pocket infection.
Summary of ISHLT 2017 Recommendations for the Medical and Surgical Management of LVAD Infections [50]
| . | Infection . | Medical Management . | Surgical Management . |
|---|---|---|---|
| LVAD-specific | Superficial DLI | IV/PO antibiotics for 2 weeks or until infection resolves | None |
| Deep DLI/PPI | IV antibiotics for 6–8 weeks or until infection resolves followed by long-term PO suppression | Surgical debridement with or without wound vacuum; new driveline exit site may be required | |
| Pump, cannula, or Bacteremia | IV antibiotics until after heart transplant or an extended course followed by PO suppression (destination therapy); ID consult is advised | Surgical drainage, debridement, or explant may be required; urgent device replacement should be considered in bridge to transplant to prevent end-organ damage that may preclude heart transplant | |
| LVAD-related | Bacteremia | Duration of antibiotics depends on the source, organism, and clearance, at least 2 weeks from first negative blood cultures | |
| Bacterial mediastinitis | Antibiotics for at least 6–8 weeks from last surgical debridement | Surgical debridement is often indicated | |
| Infective endocarditis | Same as for pump and cannula infection | Surgical intervention may be required |
| . | Infection . | Medical Management . | Surgical Management . |
|---|---|---|---|
| LVAD-specific | Superficial DLI | IV/PO antibiotics for 2 weeks or until infection resolves | None |
| Deep DLI/PPI | IV antibiotics for 6–8 weeks or until infection resolves followed by long-term PO suppression | Surgical debridement with or without wound vacuum; new driveline exit site may be required | |
| Pump, cannula, or Bacteremia | IV antibiotics until after heart transplant or an extended course followed by PO suppression (destination therapy); ID consult is advised | Surgical drainage, debridement, or explant may be required; urgent device replacement should be considered in bridge to transplant to prevent end-organ damage that may preclude heart transplant | |
| LVAD-related | Bacteremia | Duration of antibiotics depends on the source, organism, and clearance, at least 2 weeks from first negative blood cultures | |
| Bacterial mediastinitis | Antibiotics for at least 6–8 weeks from last surgical debridement | Surgical debridement is often indicated | |
| Infective endocarditis | Same as for pump and cannula infection | Surgical intervention may be required |
Abbreviations: BSI, bloodstream infection; DLI, driveline infection; ID, infectious disease; IE, infective endocarditis; IV, intravenous; LVAD, left ventricular assist device; PO, oral; PPI, pump pocket infection.
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