Introduction
The management of end stage heart failure remains limited by donor
availability and recipient candidacy, which has resulted in increasing
use of mechanical circulatory support (MCS) as bridge to transplantation
or permanent destination therapy. Left ventricular assist devices
(LVADs) offload a failing left ventricle, enhancing patient survival and
quality of life. As newer generations of LVADs continue to reduce
thrombosis risk our MCS patient population will continue to expand.
However, infection remains a significant complication, increasing a
patient’s morbidity and mortality. A patient’s driveline is the
percutaneous tube connecting the internal VAD pump and the
extracorporeal controlled unit. The driveline renders a patient highly
susceptible to microbial contamination and represents a common source of
infection. For this reason, Gram-positive skin flora are commonly
implicated in LVAD-associated infections, including Staphylococcus
aureus 1. The management of this patient
population is guided by observational data and expert opinion and may be
further complicated by pathogen type, infection location, and patient
surgical/transplant candidacy status. While there is emerging data on
synergistic antibiotic combinations for the management of methicillin
resistant Staphylococcus aureus, there remains a significant gap
in the literature for persistent methicillin sensitiveStaphylococcus aureus ( MSSA) 2. There are a
handful of both in-vitro and in-vivo studies that suggest
a synergistic effect of cefazolin and ertapenem combination therapy for
persistent MSSA 3–5. Here we describe the successful
use of oxacillin and ertapenem combination therapy in the treatment of
LVAD-associated persistent MSSA bacteremia.