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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.