Background

Infections are the most common complication in recipients of durable left ventricular assist devices (LVAD) and are associated with increased morbidity, mortality, and expenditures. The existing literature examining factors associated with infection in LVAD recipients is limited and principally comprises single-center studies. This scoping review synthesizes all available evidence related to identifying modifiable, non-patient factors associated with infections among LVAD recipients.

Methods

Published studies were identified through searching 5 bibliographic databases: PubMed, Scopus, EMBASE, CINAHL, and Web of Science Core Collection. Inclusion criteria required examination of factors associated with infections among recipients of contemporary, implantable, continuous flow LVADs. Key study characteristics were extracted by 4 independent reviewers and current literature described narratively. The Systems Engineering Initiative for Patient Safety (SEIPS) model was used to develop a taxonomy for non-patient related factors (e.g., tasks, tools, technologies, organization, and environment) associated with infections following LVAD implantation. All analyses took place between February 2019 and May 2021.

Findings

A total of 43 studies met inclusion criteria. The majority of included studies were observational (n = 37), single-center (n = 29), from the U.S. (n = 38), and focused on driveline infections (n = 40). Among the 22 evaluated sub-domains of non-patient related factors, only two: increasing center experience and establishing a silicone-skin interface at the driveline exit site, were identified as consistently being associated with a lower risk of infection.

Conclusion

This review identified 43 studies that described non-patient related factors associated with infection in LVAD recipients. Only two factors were consistently associated with lower infection risk in LVAD recipients: increasing experience and establishing a silicone-skin interface at driveline exit site. The large variability in reporting across multiple studied interventions limited the ability to discern their effectiveness.

中文翻译：

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与 LVAD 受者感染相关的非患者因素：范围审查

背景

感染是耐用左心室辅助装置 (LVAD) 接受者最常见的并发症，并与发病率、死亡率和支出增加有关。现有的研究与 LVAD 受者感染相关因素的文献是有限的，主要包括单中心研究。该范围审查综合了所有与识别 LVAD 受者感染相关的可改变、非患者因素相关的现有证据。

方法

通过搜索 5 个书目数据库确定已发表的研究：PubMed、Scopus、EMBASE、CINAHL 和 Web of Science 核心合集。纳入标准要求检查与当代、可植入、连续流动 LVAD 接受者感染相关的因素。关键研究特征由 4 位独立评审员提取，并以叙述方式描述当前文献。患者安全系统工程倡议 (SEIPS) 模型用于开发与 LVAD 植入后感染相关的非患者相关因素（例如，任务、工具、技术、组织和环境）的分类。所有分析均在 2019 年 2 月至 2021 年 5 月之间进行。

发现

共有 43 项研究符合纳入标准。大多数纳入的研究是观察性的 ( n  = 37)、单中心 ( n  = 29)、来自美国 ( n  = 38) 的研究，并侧重于动力传动系统感染 ( n  = 40)。在 22 个非患者相关因素的评估子域中，只有两个：增加中心经验和在传动系统出口部位建立硅胶-皮肤界面，被确定为始终与较低的感染风险相关。

结论

本综述确定了 43 项研究，这些研究描述了与 LVAD 受者感染相关的非患者相关因素。只有两个因素始终与 LVAD 接受者的较低感染风险相关：增加经验和在传动系统出口部位建立硅胶-皮肤界面。多个研究干预措施报告的巨大差异限制了辨别其有效性的能力。