Impact of narrowing perioperative antibiotic prophylaxis for left ventricular assist device implantation

Lauren Allen, Rachel Bartash, Grace Y. Minamoto, Kelsie Cowman, Snehal Patel, Sasa Vukelic, Daryl U. Nnani, Daphenie Fauvel, Yi Guo

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Although infections are a significant potential complication among patients undergoing left ventricular assist device (LVAD) implantation, standardized surgical infection prophylaxis (SIP) regimens are not well defined. At Montefiore Medical Center, a 4-drug SIP regimen containing fluconazole, ciprofloxacin, rifampin, and vancomycin was previously utilized. In January 2020, the antimicrobial stewardship program implemented a 2-drug SIP regimen of vancomycin and cefazolin to limit exposure to broad-spectrum antibiotics. This study evaluated LVAD-associated infection rates prior to and following the SIP revision. Methods: A retrospective review of patients who underwent LVAD implantation from 1/2018 to 4/2021 was performed. Infections were classified using the International Society for Heart and Lung Transplantation definitions. Infection rates at 2 weeks, 30 days, and 90 days post-implantation in the 4-drug SIP regimen (1/2018-12/2019) and the 2-drug SIP regimen (1/2020 to 4/2021) were compared. Results: A total of 71 patients were included. The number of patients with LVAD-associated infections (including surgical site infections) was not significantly different in either SIP group at 2 weeks (9% vs. 4%, p =.64), 30 days (9% vs. 11%, p =.99), or 90 days (19% vs. 14%, p =.75). There was no statistically significant difference in 30 or 90-day mortality. LVAD-associated gram-negative (7% vs. 7%; p >.99) and fungal (5% vs. 0%; p =.51) infections were uncommon. The most common organism isolated was Staphylococcus aureus, and the most common type of infection was pneumonia in both SIP groups. Conclusion: No significant difference in LVAD-associated infections or infection-related mortality was observed with de-escalation of perioperative antibiotics. Additional studies with larger sample sizes are needed to endorse the findings of this study.

Original languageEnglish (US)
Article numbere13900
JournalTransplant Infectious Disease
Issue number5
StatePublished - Oct 2022


  • LVAD-associated infections
  • antimicrobial stewardship
  • device infection
  • left ventricular assist devices
  • surgical infection prophylaxis
  • surgical site infections

ASJC Scopus subject areas

  • Transplantation
  • Infectious Diseases


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