Letter:
To the Editor:
A recently published article by Peter T. Nguyen et al.1” Impact of antimicrobial selection for prophylaxis of left ventricular assist device surgical infections” catches our eyes of interest. The efforts made by the authors are of great importance and ought to be recognized by the readers. The last point made by the author is that gram-positive organisms should be covered as a priority during the implantation protocols of the left ventricular assist device.  Considering the study’s limitations, the retrospective design of this study raised many concerns as it is prone to be affected by reporting bias due to not recalling properly, which leads to indecorous documentation; this would be fair if the author has used data of the present times. This study is also threatened by publication bias because it has included participants from one selected location; it significantly affects the methodological quality, which would be corrected by conducting a multicenter study. In addition, the article does not contain information about antibiotics used to prevent infections. The other studies would have provided insight into the specificity of this case.2,3 Meropenem, linezolide and vancomycin were the most effective and widely used antibiotics of any antibiotic used. Given scrub-in procedures, which is the weakness of this study, another study highlighted that the driveline exit site should be diluted with hydrogen peroxide, and germicide occlusive gauze should be used for wound care.3 Upon completion of the process, negative pressure wound therapy may be used for rapid recovery. In addition, a study mentioned technical approaches for LVAD, including standard strategies like full median sternotomy and sternotomy sparing approaches like full lateral thoracotomy and less invasive strategy; the author fails to mention these in this article.4  Finally, it was discovered that there was a patient follow-up issue due to lack of knowledge or non-serious behaviour, which resulted in inadequate documentation. However, it is seen in another article,5 since they managed to stay in contact with their patients 2 years after the transplant. References:
  1. Nguyen, P. T., Sam, T., Colley, P., van Zyl, J. S., Felius, J., Berhe, M., & Meyer, D. (2021). Impact of antimicrobial selection for prophylaxis of left ventricular assist device surgical infections. Journal of cardiac surgery36 (9), 3052–3059. https://doi.org/10.1111/jocs.15682
  2. Angleitner, P., Matic, A., Kaider, A., Dimitrov, K., Sandner, S., Wiedemann, D., Riebandt, J., Schlöglhofer, T., Laufer, G., & Zimpfer, D. (2020). Blood stream infection and outcomes in recipients of a left ventricular assist device. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery58 (5), 907–914. https://doi.org/10.1093/ejcts/ezaa153
  3. Hieda, M., Sata, M., & Nakatani, T. (2015). The Importance of the Management of Infectious Complications for Patients with Left Ventricular Assist Device. Healthcare (Basel, Switzerland)3 (3), 750–756. https://doi.org/10.3390/healthcare3030750
  4. Loforte A, Gliozzi G, Mariani C, Cavalli GG, Martin-Suarez S, Pacini D. Ventricular assist devices implantation: surgical assessment and technical strategies. Cardiovasc Diagn Ther. 2021 Feb;11(1):277-291. doi: 10.21037/cdt-20-325. PMID: 33708499; PMCID: PMC7944211.
  5. Patel CB, Blue L, Cagliostro B, Bailey SH, Entwistle JW, John R, Thohan V, Cleveland JC Jr, Goldstein DJ, Uriel N, Su X, Somo SI, Sood P, Mehra MR. Left ventricular assist systems and infection-related outcomes: A comprehensive analysis of the MOMENTUM 3 trial. J Heart Lung Transplant. 2020 Aug;39(8):774-781. doi: 10.1016/j.healun.2020.03.002. Epub 2020 Mar 20. PMID: 32276809.