Dynamics of bacterial pathogens at the driveline exit site in patients with ventricular assist devices: a prospective, observational, single-centre cohort study.

Pitton, Melissa; Valente, Luca G; Oberhaensli, Simone; Casanova, Carlo; Sendi, Parham; Schnegg, Bruno; Jakob, Stephan M; Cameron, David R; Que, Yok-Ai; Fürholz, Monika (2023). Dynamics of bacterial pathogens at the driveline exit site in patients with ventricular assist devices: a prospective, observational, single-centre cohort study. The Journal of heart and lung transplantation, 42(10), pp. 1445-1454. Elsevier 10.1016/j.healun.2023.05.016

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BACKGROUND

Driveline infections (DLIs) at the exit site are frequent in patients with left ventricular assist devices (LVADs). The dynamics from colonization to infection are yet to be investigated. We combined systematic swabbing at the driveline exit site and genomic analyses to study the dynamics of bacterial pathogens and get insights into DLIs pathogenesis.

METHODS

A prospective, observational, single-centre cohort study at the University Hospital of Bern, Switzerland was performed. Patients with LVAD were systematically swabbed at the driveline exit site between June 2019 and December 2021, irrespective of signs and symptoms of DLI. Bacterial isolates were identified and a subset was whole-genome sequenced.

RESULTS

Fifty-three patients were screened, of which 45 (84.9%) were included in the final population. Bacterial colonization at the driveline exit site without manifestation of DLI was frequent and observed in 17 patients (37.8%). Twenty-two patients (48.9%) developed at least one DLI episode over the study period. Incidence of DLIs reached 2.3 cases per 1,000 LVAD days. The majority of the organisms cultivated from exit sites were Staphylococcus species. Genome analysis revealed that bacteria persisted at the driveline exit site over time. In four patients, transition from colonization to clinical DLI was observed.

CONCLUSION

Our study is the first to address bacterial colonization in the LVAD-DLI setting. We observed that bacterial colonization at the driveline exit site was a frequent phenomenon, and in a few cases it preceded clinically relevant infections. We also provided acquisition of hospital-acquired multidrug-resistant bacteria and the transmission of pathogens between patients.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Service Sector > Institute for Infectious Diseases > Research
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Service Sector > Institute for Infectious Diseases
04 Faculty of Medicine > Service Sector > Institute for Infectious Diseases > Clinical Microbiology
04 Faculty of Medicine > Service Sector > Institute for Infectious Diseases > General Bacteriology
04 Faculty of Medicine > Service Sector > Institute for Infectious Diseases > Mycobacteriology
08 Faculty of Science > Department of Biology > Bioinformatics and Computational Biology

Graduate School:

Graduate School for Cellular and Biomedical Sciences (GCB)

UniBE Contributor:

Pitton, Melissa Phung-Kieu, Valente, Luca Gabriele, Oberhänsli, Simone, Casanova, Carlo, Sendi, Parham, Schnegg, Bruno, Jakob, Stephan, Cameron, David Robert, Que, Yok-Ai, Fürholz, Monika

Subjects:

500 Science > 570 Life sciences; biology
600 Technology > 610 Medicine & health

ISSN:

1557-3117

Publisher:

Elsevier

Language:

English

Submitter:

Pubmed Import

Date Deposited:

30 May 2023 10:14

Last Modified:

28 May 2024 00:25

Publisher DOI:

10.1016/j.healun.2023.05.016

PubMed ID:

37245557

Uncontrolled Keywords:

Bacterial pathogens in LVAD LVAD driveline infection bacterial colonization in LVAD

BORIS DOI:

10.48350/182983

URI:

https://boris.unibe.ch/id/eprint/182983

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