Development of an infection-resistant LVAD driveline

A novel approach to the prevention of device-related infections

Lorraine Choi, Asim Choudhri, Venu G. Pillarisetty, Lester A. Sampath, Lauser Caraos, Steven R. Brunnert, Mehmet C. Oz, Shanta M. Modak

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background: Infection remains the single most important challenge to extended left ventricular assist device (LVAD) use and often arises from the percutaneous driveline exit site. We evaluated the ability of an LVAD driveline prototype impregnated with chlorhexidine, triclosan, and silver sulfadiazine to resist bacterial and fungal colonization. Methods: The spectrum and duration of antimicrobial activity were evaluated in vitro by daily transfer of driveline segments embedded on agar plates inoculated with 108 colony-forming units (CFU) of Staphylococcus aureus (S. aureus), Staphlococcus epidermidis, Enterobacter aerogenes, Psuedomonas aeruginosa, and Candida albicans, and then measuring zones of inhibition around the sample subsequent to 24 hours of incubation at 37°C. Antimicrobial activity was demonstrated against all organisms for greater than 14 days, and for over 21 days for gram-positive bacteria. To demonstrate in vivo efficacy of the treated driveline, 3-cm segments of driveline were implanted in the dorsal and ventral surface of rats. The exit site was inoculated with 106 CFU of S. aureus. After 7 days, driveline segments were aseptically explanted and assayed for bacterial colonization and retention of antimicrobial activity. One hundred percent of control segments were colonized (105 CFU S. aureus/cm) as against 13% of the test explants (≤ 330 CFU/cm; p < 0.0001).ResultsSubcultures of the insertion site and driveline pocket tissue resulted in 103 to 105 CFU per swab culture for control rats and 0 to 102 CFU/swab for test animals. Test drivelines retained 80% of anti-S. aureus activity. Gross and histological examination of the driveline and surrounding pocket revealed minimal tissue reactivity with positive signs of tissue ingrowth. Conclusion: An antimicrobial driveline may prevent early infections and facilitate ingrowth of tissue to provide long-term stability and protection against late infection. Copyright (C) 1999 International Society for Heart and Lung Transplantation.

Original languageEnglish (US)
Pages (from-to)1103-1110
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume18
Issue number11
DOIs
StatePublished - Nov 1 1999
Externally publishedYes

Fingerprint

Heart-Assist Devices
Stem Cells
Equipment and Supplies
Staphylococcus aureus
Infection
Triclosan
Silver Sulfadiazine
Enterobacter aerogenes
Chlorhexidine
Gram-Positive Bacteria
Candida albicans
Agar

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

Development of an infection-resistant LVAD driveline : A novel approach to the prevention of device-related infections. / Choi, Lorraine; Choudhri, Asim; Pillarisetty, Venu G.; Sampath, Lester A.; Caraos, Lauser; Brunnert, Steven R.; Oz, Mehmet C.; Modak, Shanta M.

In: Journal of Heart and Lung Transplantation, Vol. 18, No. 11, 01.11.1999, p. 1103-1110.

Research output: Contribution to journalArticle

Choi, Lorraine ; Choudhri, Asim ; Pillarisetty, Venu G. ; Sampath, Lester A. ; Caraos, Lauser ; Brunnert, Steven R. ; Oz, Mehmet C. ; Modak, Shanta M. / Development of an infection-resistant LVAD driveline : A novel approach to the prevention of device-related infections. In: Journal of Heart and Lung Transplantation. 1999 ; Vol. 18, No. 11. pp. 1103-1110.
@article{8e6444157779419ba7daf54c4a772c72,
title = "Development of an infection-resistant LVAD driveline: A novel approach to the prevention of device-related infections",
abstract = "Background: Infection remains the single most important challenge to extended left ventricular assist device (LVAD) use and often arises from the percutaneous driveline exit site. We evaluated the ability of an LVAD driveline prototype impregnated with chlorhexidine, triclosan, and silver sulfadiazine to resist bacterial and fungal colonization. Methods: The spectrum and duration of antimicrobial activity were evaluated in vitro by daily transfer of driveline segments embedded on agar plates inoculated with 108 colony-forming units (CFU) of Staphylococcus aureus (S. aureus), Staphlococcus epidermidis, Enterobacter aerogenes, Psuedomonas aeruginosa, and Candida albicans, and then measuring zones of inhibition around the sample subsequent to 24 hours of incubation at 37°C. Antimicrobial activity was demonstrated against all organisms for greater than 14 days, and for over 21 days for gram-positive bacteria. To demonstrate in vivo efficacy of the treated driveline, 3-cm segments of driveline were implanted in the dorsal and ventral surface of rats. The exit site was inoculated with 106 CFU of S. aureus. After 7 days, driveline segments were aseptically explanted and assayed for bacterial colonization and retention of antimicrobial activity. One hundred percent of control segments were colonized (105 CFU S. aureus/cm) as against 13{\%} of the test explants (≤ 330 CFU/cm; p < 0.0001).ResultsSubcultures of the insertion site and driveline pocket tissue resulted in 103 to 105 CFU per swab culture for control rats and 0 to 102 CFU/swab for test animals. Test drivelines retained 80{\%} of anti-S. aureus activity. Gross and histological examination of the driveline and surrounding pocket revealed minimal tissue reactivity with positive signs of tissue ingrowth. Conclusion: An antimicrobial driveline may prevent early infections and facilitate ingrowth of tissue to provide long-term stability and protection against late infection. Copyright (C) 1999 International Society for Heart and Lung Transplantation.",
author = "Lorraine Choi and Asim Choudhri and Pillarisetty, {Venu G.} and Sampath, {Lester A.} and Lauser Caraos and Brunnert, {Steven R.} and Oz, {Mehmet C.} and Modak, {Shanta M.}",
year = "1999",
month = "11",
day = "1",
doi = "10.1016/S1053-2498(99)00076-5",
language = "English (US)",
volume = "18",
pages = "1103--1110",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
publisher = "Elsevier USA",
number = "11",

}

TY - JOUR

T1 - Development of an infection-resistant LVAD driveline

T2 - A novel approach to the prevention of device-related infections

AU - Choi, Lorraine

AU - Choudhri, Asim

AU - Pillarisetty, Venu G.

AU - Sampath, Lester A.

AU - Caraos, Lauser

AU - Brunnert, Steven R.

AU - Oz, Mehmet C.

AU - Modak, Shanta M.

PY - 1999/11/1

Y1 - 1999/11/1

N2 - Background: Infection remains the single most important challenge to extended left ventricular assist device (LVAD) use and often arises from the percutaneous driveline exit site. We evaluated the ability of an LVAD driveline prototype impregnated with chlorhexidine, triclosan, and silver sulfadiazine to resist bacterial and fungal colonization. Methods: The spectrum and duration of antimicrobial activity were evaluated in vitro by daily transfer of driveline segments embedded on agar plates inoculated with 108 colony-forming units (CFU) of Staphylococcus aureus (S. aureus), Staphlococcus epidermidis, Enterobacter aerogenes, Psuedomonas aeruginosa, and Candida albicans, and then measuring zones of inhibition around the sample subsequent to 24 hours of incubation at 37°C. Antimicrobial activity was demonstrated against all organisms for greater than 14 days, and for over 21 days for gram-positive bacteria. To demonstrate in vivo efficacy of the treated driveline, 3-cm segments of driveline were implanted in the dorsal and ventral surface of rats. The exit site was inoculated with 106 CFU of S. aureus. After 7 days, driveline segments were aseptically explanted and assayed for bacterial colonization and retention of antimicrobial activity. One hundred percent of control segments were colonized (105 CFU S. aureus/cm) as against 13% of the test explants (≤ 330 CFU/cm; p < 0.0001).ResultsSubcultures of the insertion site and driveline pocket tissue resulted in 103 to 105 CFU per swab culture for control rats and 0 to 102 CFU/swab for test animals. Test drivelines retained 80% of anti-S. aureus activity. Gross and histological examination of the driveline and surrounding pocket revealed minimal tissue reactivity with positive signs of tissue ingrowth. Conclusion: An antimicrobial driveline may prevent early infections and facilitate ingrowth of tissue to provide long-term stability and protection against late infection. Copyright (C) 1999 International Society for Heart and Lung Transplantation.

AB - Background: Infection remains the single most important challenge to extended left ventricular assist device (LVAD) use and often arises from the percutaneous driveline exit site. We evaluated the ability of an LVAD driveline prototype impregnated with chlorhexidine, triclosan, and silver sulfadiazine to resist bacterial and fungal colonization. Methods: The spectrum and duration of antimicrobial activity were evaluated in vitro by daily transfer of driveline segments embedded on agar plates inoculated with 108 colony-forming units (CFU) of Staphylococcus aureus (S. aureus), Staphlococcus epidermidis, Enterobacter aerogenes, Psuedomonas aeruginosa, and Candida albicans, and then measuring zones of inhibition around the sample subsequent to 24 hours of incubation at 37°C. Antimicrobial activity was demonstrated against all organisms for greater than 14 days, and for over 21 days for gram-positive bacteria. To demonstrate in vivo efficacy of the treated driveline, 3-cm segments of driveline were implanted in the dorsal and ventral surface of rats. The exit site was inoculated with 106 CFU of S. aureus. After 7 days, driveline segments were aseptically explanted and assayed for bacterial colonization and retention of antimicrobial activity. One hundred percent of control segments were colonized (105 CFU S. aureus/cm) as against 13% of the test explants (≤ 330 CFU/cm; p < 0.0001).ResultsSubcultures of the insertion site and driveline pocket tissue resulted in 103 to 105 CFU per swab culture for control rats and 0 to 102 CFU/swab for test animals. Test drivelines retained 80% of anti-S. aureus activity. Gross and histological examination of the driveline and surrounding pocket revealed minimal tissue reactivity with positive signs of tissue ingrowth. Conclusion: An antimicrobial driveline may prevent early infections and facilitate ingrowth of tissue to provide long-term stability and protection against late infection. Copyright (C) 1999 International Society for Heart and Lung Transplantation.

UR - http://www.scopus.com/inward/record.url?scp=0032704593&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032704593&partnerID=8YFLogxK

U2 - 10.1016/S1053-2498(99)00076-5

DO - 10.1016/S1053-2498(99)00076-5

M3 - Article

VL - 18

SP - 1103

EP - 1110

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

IS - 11

ER -