Enterococcal Infections in Left Ventricular Assist Device Recipients: Two Clinical Cases and Systematic Review.

Background

Infections remain a major complication in patients with left ventricular assist devices (LVADs). Enterococcal infections are increasingly recognized and are therapeutically challenging because of antimicrobial tolerance, biofilm formation on prosthetic material, and the frequent impossibility of device removal. Objective and method: We report two clinical cases of Enterococcus faecalis LVAD infection and a PRISMA-based systematic review of cases published between 1996 and 2025 that were identified through PubMed/MEDLINE. Primary outcomes were clinical cure, relapse or recurrence, mortality, and device removal. Results were synthesized descriptively.

Results

Seventeen cases were analyzed, including 15 previously reported cases and two new cases. E. faecalis accounted for 47% of infections, Enterococcus faecium for 29%, and Enterococcus spp. without species identification for 24%. Bacteremia was the most common presentation, occurring in 76%, whereas LVAD-associated endocarditis occurred in 18%. Driveline or pocket involvement was reported in 41%. Suppressive antimicrobial therapy (SAT) was used in 29%, often as a bridge to heart transplantation. Cultures from explanted LVAD components were positive in 47% of cases despite prolonged antimicrobial therapy. Recurrence or relapse and overall mortality each occurred in 18% of patients.

Conclusions

Enterococcal LVAD infections may be associated with microbiological persistence despite prolonged therapy. SAT may help control infection in selected patients and bridge to heart transplantation when device removal is not feasible.