Antibiotic Treatment of Gram-Negative Bacterial Left Ventricular Assist Device Infections: A Systematic Review

Background: Gram-negative bacterial left ventricular assist device (LVAD) infections pose significant challenges due to antimicrobial resistance and high relapse rates. Moreover, current standardized treatment guidelines remain limited. Thus, this study aimed to evaluate current antimicrobial strategies for Gram-negative bacterial LVAD infections, highlight treatment trends, and examine outcomes to inform clinical decision-making. Methods: A systematic review was conducted in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they reported antibiotic regimens for Gram-negative LVAD-specific infections and the clinical outcomes of these infections. Antibiotic regimens, associated management strategies, and clinical outcomes were summarized by infection location. Results: A total of 15 studies were included, reporting 25 cases of Gram-negative LVAD-specific infections and 28 identified Gram-negative pathogens. Most cases involved superficial or deep driveline/exit-site/pocket infections (16/25, 64.0%), whereas pump/cannula infections and device-specific bloodstream infections occurred in 3/25 (12.0%) and 6/25 (24.0%) patients, respectively. Antibiotic strategies varied widely in both selection and duration. Superficial driveline and exit-site infections were treated with a median of 14 days of antibiotics (interquartile range (IQR), 14–21.5; range, 7–49), whereas deep driveline/pocket infections required longer treatment with a median of 42 days (IQR, 31.5–42; range, 14–42). Pump/cannula and bloodstream infections often required prolonged therapy, suppressive treatment, and/or major surgical intervention. Conclusions: The treatment of Gram-negative bacterial LVAD infections remains highly variable and poorly characterized due to the limited number of reported cases, making it difficult to establish evidence-based clinical recommendations. This highlights the urgent need for further research to establish evidence-based treatment protocols and improve patient outcomes.