Left ventricular assist device-associated driveline infections as a specific form of complicated skin and soft tissue infection/acute bacterial skin and skin structure infection – issues and therapeutic options

Abstract

Purpose of review This review comments on the current guidelines for the treatment of wound infections under definition of acute bacterial skin and skin structure infections (ABSSSI). However, wound infections around a catheter, such as driveline infections of a left ventricular assist device (LVAD) are not specifically listed under this definition in any of the existing guidelines. Recent findings Definitions and classification of LVAD infections may vary across countries, and the existing guidelines and recommendations may not be equally interpreted among physicians, making it unclear if these infections can be considered as ABSSSI. Consequently, the use of certain antibiotics that are approved for ABSSSI may be considered as ‘off-label’ for LVAD infections, leading to rejection of reimbursement applications in some countries, affecting treatment strategies, and hence, patients’ outcomes. However, we believe driveline exit site infections related to LVAD can be included within the ABSSSI definition. Summary We argue that driveline infections meet the criteria for ABSSSI which would enlarge the ‘on-label’ antibiotic armamentarium for treating these severe infections, thereby improving the patients’ quality of life.