A Case-Based Review of LVAD Infection by MABC

Abstract

Abstract We present a review of literature and report a case of left ventricular assist device (LVAD) infection and postsurgical wound infection with Mycobacterium abscessus complex (MABC) following exposure to sewage and tap water, respectively. The initial infectious process involved the driveline and the deep pocket and progressed to involve LVAD. Prior to availability of culture results, the patient was started on linezolid followed by surgical debridement of driveline site and change of exit site. The debrided tissue grew a smooth and a rough colony variant of MABC. After 2 weeks of imipenem intravenous (IV), tigecycline IV, azithromycin oral (PO), and tedizolid PO, the patient presented to us with worsening of wound status. Antimicrobial therapy was changed to amikacin IV, imipenem IV, and cefoxitin IV along with bedside debridement, removal of 3 sutures, and placement of wound vacuum device. Amikacin IV, imipenem IV, and cefoxitin IV were then replaced with Recarbio (imipenem/cilastatin/relebactam) IV plus amoxicillin PO with significant improvement. The patient underwent LVAD removal and heart transplantation after 5 weeks and was discharged 15 days later. Following showering at home, the patient developed signs of extensive infection involving the surgical wound (chest and abdominal walls). Tigecycline IV and azithromycin IV were started. Imipenem/cilastatin/ relebactam IV plus amoxicillin PO were replaced by bedaquiline PO because of the continued financial burden to the patient. The patent was discharged on bedaquiline PO and azithromycin PO to complete 18 months of antimicrobial therapy at which time he was enjoying a very active lifestyle as he did prior to the diagnosis of advanced heart failure. He continues to do well 2 years 9 months after heart transplantation and more than a year after stopping all antimycobacterial therapy.