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Infection Control and Prevention Consensus for Mechanical Circulatory Support (MCS)

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Shimon Kusne, MD
Mayo Clinic
Phoenix, AZ, USA

Infection, with significant morbidity and mortality, is a common complication after implantation of Mechanical Circulatory Support (MCS) devices. In some early series up to 80% of the patients developed at least one infection. Until recently it was impossible to compare the rates of infection complications because authors used different definitions. In 2010 the Infectious Diseases Council developed and published definitions which are now being used by investigators in and outside the US. Currently there are no established infection prevention practices and most centers are using their own protocols.

Recently the ISHLT ID council conducted a questionnaire to investigate the current infection control practices. This was an electronic survey with 137 participating centers under the direction of Dr. Kusne from Mayo Clinic in Arizona with support of ISHLT (publication in progress). The questionnaire showed us that there is a tremendous amount of variability between centers regarding their infection control and prevention practices. Because of the lack of infection prevention trials, many centers are using protocols developed by local "experts". Therefore, guidelines are needed to direct investigators in centers performing MCS operations to use common practices for prevention. At the same time, prospective clinical trials are needed between collaborating centers to explore preventive strategies in this population. The ISHLT, through the Infectious Diseases Council, is interested in bringing centers together to perform prospective trials and promote better practices in this important field of infection prevention.

The ID council has received approval to develop a reference document regarding MCS recipients which will guide clinicians in preventing and managing infections in MCS recipients. The ISHLT Infectious Diseases council, in collaboration with ICCAC, has started working on this consensus document for strategies to prevent and manage infections in MCS recipients. This is a multidisciplinary effort in collaboration with many ISHLT councils including Infectious Diseases, Cardiology, Pediatrics, Cardiothoracic Surgery, Nursing, and Pharmacy from the US and outside the US. For the purpose of this project a working team was created which includes a Chair (Shimon Kusne, Infectious Diseases) together with five co-Chairs (Lars Lund, Cardiology; George Wieselthaler, Surgery; Haifa Lyster, Pharmacy; Annemarie Kaan, Nursing, Shirish Huprikar, Infectious Diseases). Also very instrumental in putting together this effort are previous and current ID council Chairs (Fernanda Silveira, Lara Danziger-Isakov, Martha Mooney, and Paolo Grossi). The names of the potential co-authors were suggested to us by the different ISHLT subspecialty councils. Some of them are serving as writers and others are serving as reviewers. After completion, the document will undergo careful review by 8 external experts in and outside the US. The consensus document will cover the following subjects:

  1. Background of the Project and Infectious Diseases evaluation of MCS candidates
  2. Peri-operative management in OR and antibiotic prophylaxis
  3. Post-operative management including nursing and management of infections

The creation of this document is in progress with a plan to have the first draft sometime in August 2015. The intention is to publish this consensus document in Journal of Heart and Lung Transplantation. ■

Disclosure Statement: The author has no conflicts of interest to disclose.

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