Driveline Infections in Durable LVAD Support: Risk Factors, Microbiology, and Resistance Patterns from a Large Cohort

Background: Driveline infection (DLI) is the most common device-specific infection in patients supported with ventricular assist devices (VADs) and remains a major cause of morbidity during long-term mechanical circulatory support. This study aimed to evaluate the incidence, risk factors, microbiological characteristics, and antimicrobial resistance patterns of DLIs in patients undergoing durable left ventricular assist device (LVAD) implantation. Methods: This retrospective cohort study included 772 consecutive patients who underwent durable LVAD implantation at a single tertiary center between January 2012 and December 2024. Patients were categorized according to the development of DLI: the DLI group (n = 158) and the non-DLI group (n = 614). Demographic, clinical, laboratory, perioperative, and postoperative variables were analyzed. Multivariate logistic regression analysis was performed to identify independent predictors of DLI. Microbiological isolates and antimicrobial resistance patterns were also evaluated. Results: Driveline infection developed in 20.5% of patients during follow-up. Patients with DLI had a significantly higher body mass index (26.4 vs. 24.8 kg/m2, p = 0.002) and a higher prevalence of diabetes mellitus (28.2% vs. 12.1%, p < 0.001). In multivariate analysis, diabetes mellitus (OR 3.29, p = 0.013) and longer LVAD support duration (p = 0.003) were independently associated with DLI. Device type showed differences in crude infection rates but was not an independent predictor. The most frequently isolated pathogens were Staphylococcus aureus (36%) and Pseudomonas aeruginosa (19%). The most common antimicrobial resistance patterns included fluoroquinolone resistance (23%), methicillin-resistant Staphylococcus aureus (10%), and resistance to piperacillin/tazobactam and carbapenems. Conclusions: In this large single-center cohort, diabetes mellitus and prolonged device support duration were the main independent predictors of driveline infection. Staphylococcus aureus and Pseudomonas aeruginosa were the predominant pathogens, with notable antimicrobial resistance patterns. These findings highlight the importance of metabolic optimization, meticulous driveline exit-site care, and structured long-term surveillance strategies for reducing infection risk in LVAD recipients.