Background: Owing to this improved technology and peri-implantation care around 90% of patients being considered for mechanical circulatory support receive an LVAD. Although LVAD support is associated with improved survival and quality of life, infectious complications remain a major limitation. The exact incidence of LVAD-related and non-VAD related infections among patients with VADs is unknown. Several potential factors make patients with VADs more prone to infectious complications, most obvious being the presence of an implanted device. Temporary alterations in the host immune system, including changes in T-cell function and quantity, have been observed after VAD implantation and may contribute to development of VAD-related infections. The optimal approach to empiric antibiotic therapy and duration of treatment has yet to be fully elucidated. Current treatment recommendations are based on observational studies and expert opinion, as no randomized controlled trials have evaluated empiric treatment of VAD infections. In the past several years we have expanded our understanding of driveline infections in VAD patients. However, information about non-drive line infections in VAD patients remains limited.
Study Objectives: This is a quality-improvement (QI) project to look for preventable causes of driveline as well as non-driveline infections (i.e. VAD related and non-VAD related infections) among LVAD patients cared for at University of Kansas Medical Center. Primary Objectives a) Investigate the incidence and types of non-driveline infections among LVAD patients within the first six months of their VAD implantation. b) Investigate the incidence of driveline infections among LVAD patients within the first six months of their VAD implantation. c) Identify potentially preventable causes of driveline and non-driveline infections and propose interventions to reduce the future incidence of such infections. Secondary Objective a) Share our findings with our leadership with the ultimate goal of developing recommendations on empiric antibiotic treatments based on patient-specific risk factors Study Methods: We will perform retrospective chart review of LVAD patients to establish the incidence and types of infections among these patients within the first six months of LVAD implantation. Study will only include patients who received their LVAD implantations at University of Kansas Medical Center between October 2015 and October 2017. Data collection will include patient demographics, co-morbidities and risk factors for infections, as well as infection-focused information including site of acquisition and time to onset, causative organism, and microbiological data (e.g., cultures and sensitivities, viral panels, MIC, MRSA screen) and duration of therapy.