- Email: [email protected]
A Comprehensive In Vitro Evaluation of Medihoney as an Anti-Biofilm Agent in Preventing Ventricular Assist Device Driveline Infections
Abstracts in VAD-specific infections, compared to VAD-related (71%) and nonVAD infections (72%, p<0.001). Conclusion: The ISHLT categorization of VAD infections unveils notable differences in associated risk of stroke and mortality. A re-assessment of transplant prioritization for eligible infected VAD patients may be useful to increase transplant related survival benefit.
S101 infection had a higher bleeding rate in axial compared to centrifugal (19.8 vs. 13.1, p<0.01). Conclusion: VAD infection rates were higher in axial devices both in the early and late time periods following device implant; younger patients had a higher hazard of VAD infection in this group. VAD infection was associated with higher bleeding and mortality in both flow type groups. Infection prevention programs specifically targeting VAD infections should be a key component of VAD research. 226 A Comprehensive In Vitro Evaluation of Medihoney as an Anti-Biofilm Agent in Preventing Ventricular Assist Device Driveline Infections Y. Qu,1 D. McGiffin,2 C. Kure,2 J. McLean,2 C. Duncan,2 and A.Y. Peleg.1. 1Infectious Diseases, The Alfred Hospital and Monash University, Clayton, Australia; and the 2Cardiothoracic Surgery, The Alfred Hospital and Monash University, Melbourne, Australia.
225 Epidemiology, Outcomes, and Effects of Device Flow Type on Ventricular Assist Devices (VAD) Infections: An IMACS Registry Analysis R. Xie,1 J. Cowger,2 J.K. Kirklin,1 M.M. Hannan,3 D.J. Goldstein,4 and S. Aslam.5 1Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL; 2Henry Ford Hospitals, Farmington Hills, MI; 3Mater Misericordiae University Hospital, Dublin, Ireland; 4Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY; and the 5Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA. Purpose: Infection remains an important cause of morbidity and mortality in continuous flow ventricular assist device (CF-VAD) recipients. It is unclear if flow type (axial or centrifugal) is associated with VAD infection and post-infection outcomes. This study aimed to investigate the device flow-type-specific rates of VAD infection and subsequent outcomes. Methods: We analyzed IMACS adult patients with CF-LVADs from 20132017. We defined VAD infection using the ISHLT definitions as both VAD-specific infections including driveline, pump pocket/interior/exit cannula infection, and VAD-related infections including mediastinitis and VAD-related bloodstream infection. We compared the rates of VAD infections and post-infection events by flow type. Results: Patients with axial devices (N=9988) had both higher early (<=3 months) and late (>3 months) rates (per 100 patient-months) of developing VAD infections compared to those with centrifugal (N=5572; Early: 2.3 vs. 1.8, p<0.0001; Late: 1.5 vs. 1.4, p=0.04). Younger patients (18-40 years) with axial flow support were significantly less likely to be free from infection at 2 years compared to centrifugal flow, 64.8% vs. 76.1%, p<0.0001. Early-onset VAD infection in patients on support longer than 3 months was associated with higher post-3-to-6-month bleeding rates in both groups compared to uninfected patients (Axial: 19.8 vs. 3.2, p<0.0001; Centrifugal: 13.1 vs. 7.9, p<0.01) and a higher ischemic stroke rate in axial patients (1.81 vs. 0.93, p=0.01). Patients with early-onset VAD infection had a significant higher post-3-month mortality compared to un-infected patients (2-year survival: 64.1% vs. 77.1%, p<0.0001) yet similar post-infection mortality in axial and centrifugal (2-year survival: 64.6% vs. 63.0%, p=0.82). Furthermore, patients with early-onset VAD
Purpose: Medihoney is routinely applied to the exit site of Ventricular Assist Device (VAD) drivelines in patients in many Australian hospitals to prevent driveline infections. Its effectiveness as a prophylactic measure remains unclear. We performed a comprehensive in vitro study using microbiological assays that closely mimic the in vivo environment of the driveline exit-site to assess the effectiveness of medihoney in preventing biofilm-related driveline infections. Methods: Antimicrobial efficacy testing of medihoney was performed against 24 clinically-relevant bacterial and fungal strains grown as planktonic and biofilm cells. The minimum inhibitory concentration (MIC), minimum biofilm inhibitory concentration, minimum eradication concentration of medihoney, and the activity of individual components of medihoney were assessed. A colony biofilm assay and a drip-flow biofilm reactor assay that mimic chronic wounds and the driveline exit site were used to evaluate medihoney activity in inhibiting early adherent organism monolayers and mature biofilms. Results: Medihoney demonstrated activity against planktonic organism cells in 5/6 S. aureus strains, 6/6 of S. epidermidis strains, 1/6 of P. aeruginosa strains and 4/6 of Candida strains using a qualitative disk diffusion susceptibility assay and a quantitative broth microdilution assay [MICs, 10% weight/volume (W/V) medihoney concentrations]. Higher concentrations of medihoney (30-50%, W/V) were required to inhibit the growth of biofilm cells. Eradication of biofilms could not be achieved by medihoney, even at the highest concentration studied. The antibiofilm properties of medihoney were multi-faceted, including sugar content, pH, osmolality and the proposed active ingredient, methylglyoxal (MGO). MGO actually played a less important role than other medihoney characteristics. The colony biofilm assay and the drip flow biofilm reactor showed that medihoney was unable to prevent the maturation of biofilms after early organism adherence, and only had a weak activity against established biofilms. Conclusion: Our work suggests a suboptimal effectiveness of medihoney in preventing driveline exit site infections due to biofilm development, warranting further clinical trials before its widespread use can be justified. 227 Efficacy of Pump Exchange with a Left Ventricular Assist Device Associated Infection L. Coyle, C. Gallagher, W. Cotts, P. Pappas and A. Tatooles. Heart and Vascular Institute, Advocate Christ Medical Center, Oak Lawn, IL. Purpose: Left ventricular assist device (LVAD) exchange for source control of infection has been suggested as a treatment option for LVAD-associated infections (LVADI). However, there are limited data regarding the efficacy and outcomes of these patients. We reviewed the clinical outcomes of patients undergoing a device exchange in the presence of persistent and severe VAD-specific and VAD-related infections. Methods: We retrospectively reviewed all patients (n=80) at our center who underwent a CF-LVAD exchange between January 2005 and October 2016. Patients with a LVADI, defined using the International Society of Heart and Lung Transplant criteria were further evaluated. The primary
S101 infection had a higher bleeding rate in axial compared to centrifugal (19.8 vs. 13.1, p<0.01). Conclusion: VAD infection rates were higher in axial devices both in the early and late time periods following device implant; younger patients had a higher hazard of VAD infection in this group. VAD infection was associated with higher bleeding and mortality in both flow type groups. Infection prevention programs specifically targeting VAD infections should be a key component of VAD research. 226 A Comprehensive In Vitro Evaluation of Medihoney as an Anti-Biofilm Agent in Preventing Ventricular Assist Device Driveline Infections Y. Qu,1 D. McGiffin,2 C. Kure,2 J. McLean,2 C. Duncan,2 and A.Y. Peleg.1. 1Infectious Diseases, The Alfred Hospital and Monash University, Clayton, Australia; and the 2Cardiothoracic Surgery, The Alfred Hospital and Monash University, Melbourne, Australia.
225 Epidemiology, Outcomes, and Effects of Device Flow Type on Ventricular Assist Devices (VAD) Infections: An IMACS Registry Analysis R. Xie,1 J. Cowger,2 J.K. Kirklin,1 M.M. Hannan,3 D.J. Goldstein,4 and S. Aslam.5 1Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL; 2Henry Ford Hospitals, Farmington Hills, MI; 3Mater Misericordiae University Hospital, Dublin, Ireland; 4Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY; and the 5Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA. Purpose: Infection remains an important cause of morbidity and mortality in continuous flow ventricular assist device (CF-VAD) recipients. It is unclear if flow type (axial or centrifugal) is associated with VAD infection and post-infection outcomes. This study aimed to investigate the device flow-type-specific rates of VAD infection and subsequent outcomes. Methods: We analyzed IMACS adult patients with CF-LVADs from 20132017. We defined VAD infection using the ISHLT definitions as both VAD-specific infections including driveline, pump pocket/interior/exit cannula infection, and VAD-related infections including mediastinitis and VAD-related bloodstream infection. We compared the rates of VAD infections and post-infection events by flow type. Results: Patients with axial devices (N=9988) had both higher early (<=3 months) and late (>3 months) rates (per 100 patient-months) of developing VAD infections compared to those with centrifugal (N=5572; Early: 2.3 vs. 1.8, p<0.0001; Late: 1.5 vs. 1.4, p=0.04). Younger patients (18-40 years) with axial flow support were significantly less likely to be free from infection at 2 years compared to centrifugal flow, 64.8% vs. 76.1%, p<0.0001. Early-onset VAD infection in patients on support longer than 3 months was associated with higher post-3-to-6-month bleeding rates in both groups compared to uninfected patients (Axial: 19.8 vs. 3.2, p<0.0001; Centrifugal: 13.1 vs. 7.9, p<0.01) and a higher ischemic stroke rate in axial patients (1.81 vs. 0.93, p=0.01). Patients with early-onset VAD infection had a significant higher post-3-month mortality compared to un-infected patients (2-year survival: 64.1% vs. 77.1%, p<0.0001) yet similar post-infection mortality in axial and centrifugal (2-year survival: 64.6% vs. 63.0%, p=0.82). Furthermore, patients with early-onset VAD
Purpose: Medihoney is routinely applied to the exit site of Ventricular Assist Device (VAD) drivelines in patients in many Australian hospitals to prevent driveline infections. Its effectiveness as a prophylactic measure remains unclear. We performed a comprehensive in vitro study using microbiological assays that closely mimic the in vivo environment of the driveline exit-site to assess the effectiveness of medihoney in preventing biofilm-related driveline infections. Methods: Antimicrobial efficacy testing of medihoney was performed against 24 clinically-relevant bacterial and fungal strains grown as planktonic and biofilm cells. The minimum inhibitory concentration (MIC), minimum biofilm inhibitory concentration, minimum eradication concentration of medihoney, and the activity of individual components of medihoney were assessed. A colony biofilm assay and a drip-flow biofilm reactor assay that mimic chronic wounds and the driveline exit site were used to evaluate medihoney activity in inhibiting early adherent organism monolayers and mature biofilms. Results: Medihoney demonstrated activity against planktonic organism cells in 5/6 S. aureus strains, 6/6 of S. epidermidis strains, 1/6 of P. aeruginosa strains and 4/6 of Candida strains using a qualitative disk diffusion susceptibility assay and a quantitative broth microdilution assay [MICs, 10% weight/volume (W/V) medihoney concentrations]. Higher concentrations of medihoney (30-50%, W/V) were required to inhibit the growth of biofilm cells. Eradication of biofilms could not be achieved by medihoney, even at the highest concentration studied. The antibiofilm properties of medihoney were multi-faceted, including sugar content, pH, osmolality and the proposed active ingredient, methylglyoxal (MGO). MGO actually played a less important role than other medihoney characteristics. The colony biofilm assay and the drip flow biofilm reactor showed that medihoney was unable to prevent the maturation of biofilms after early organism adherence, and only had a weak activity against established biofilms. Conclusion: Our work suggests a suboptimal effectiveness of medihoney in preventing driveline exit site infections due to biofilm development, warranting further clinical trials before its widespread use can be justified. 227 Efficacy of Pump Exchange with a Left Ventricular Assist Device Associated Infection L. Coyle, C. Gallagher, W. Cotts, P. Pappas and A. Tatooles. Heart and Vascular Institute, Advocate Christ Medical Center, Oak Lawn, IL. Purpose: Left ventricular assist device (LVAD) exchange for source control of infection has been suggested as a treatment option for LVAD-associated infections (LVADI). However, there are limited data regarding the efficacy and outcomes of these patients. We reviewed the clinical outcomes of patients undergoing a device exchange in the presence of persistent and severe VAD-specific and VAD-related infections. Methods: We retrospectively reviewed all patients (n=80) at our center who underwent a CF-LVAD exchange between January 2005 and October 2016. Patients with a LVADI, defined using the International Society of Heart and Lung Transplant criteria were further evaluated. The primary