Oritavancin in LVAD related infections - a chance for shortening therapy and improving outcomes

LVAD utility in heart failure patients is growing. Despite advancement in technology rates of LVAD- related infections remain high limiting outcomes. We aimed to assess the effectiveness and safety of oritavancin for LVAD-related Gram-positive infections. A retrospective study evaluating adult LVAD patients who received ≥ 1 oritavancin dose for treatment of Gram-positive LVAD-related infection between September 2022 and December 2024. Oritavancin was given at the end of shortened standard antibiotic therapy. The primary endpoint was 90-day clinical and microbiological cure of the primary or relapsing infection within 90 days from the first oritavancin dose. Secondary endpoints were adverse events. Overall, nine patients were included. All were male, mean age was 53 ± 9 years. In total they experienced 10 LVAD- related episodes. Most episodes (80%) were deep drive-line infections. The organism most commonly responsible for infection was Staphyloccocus aureus. Oritavancin was administered after a median time of 31 ± 13 days of standard antibiotic therapy. In total 18 doses of oritavancin were administered with a median of 2 per case separated on average by 20 ± 4 days. Primary endpoint was achieved in 90% of cases, shortening therapy by a median time of 24 days. Serious adverse events occurred in two of 9 patients: delirium and shivers, both with transient increase of inflammatory markers. Oritavancin has a potential to shorten inhospital therapy and improve outcomes in LVAD-related Gram-positive infections in advanced heart failure patients. The study is the first to report delirium and transient increase in inflammatory biomarkes as side effects.