19.3 Evidence for managing infection in patients with mechanical circulatory support
Whenever clinically feasible, infection should be excluded or appropriately treated before MCS implantation. In candidates for MCS before implantation, evaluation of suspected infection is no different from that in other patients and should be guided by clinical signs and symptoms. In patients with unexplained fever and/or leucocytosis, evaluation should include blood cultures, urinalysis, urine culture and chest radiogram, with additional imaging as needed until a diagnosis is established and the source has been treated and cleared. In all MCS candidates with suspected or proven infection, expert infection consultation is advisable. MCS candidates with BSI should be treated with targeted antimicrobial therapy [363].
For an active infection, there is insufficient evidence to define a minimum duration of antimicrobial therapy before proceeding to MCS implantation [26]. However, delaying MCS implantation is recommended where feasible until the following general goals are met: control of the source (e.g. incision and drainage of abscess, removal of infected catheter or tooth extraction for dental abscess); blood culture results have become negative after appropriate antibiotic treatment commenced; and illness and sepsis are resolved. Candidates for MCS with other infections (e.g. pneumonia, urinary tract infection) should be treated with appropriate antimicrobial therapy until resolution. Expert infection consultation should be sought in all cases of infection preimplantation and throughout the perioperative period.