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Volume 15
Issue 6
10.3390/pathogens15060626
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Systematic Review

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

by
Cristina Gay
1,†,
Lucía Ramos-Merino
2,†,
Elena Sandoval
3,
David Couto-Mallón
4,
Andrés Perissinotti
5,6,
María García-Vieites
7,
Eduardo Barge-Caballero
4,
Marta Farrero
8,
Marta Hernández-Meneses
1,*,‡ and
María G. Crespo-Lerio
4,‡
1
Department of Infectious Diseases, Hospital Clínic de Barcelona—IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
2
Department of Infectious Diseases, Hospital Universitario A Coruña, 15006 A Coruña, Spain
3
Department of Cardiovascular Surgery, Hospital Clínic de Barcelona—IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
4
Cardiology Department, Hospital Universitario A Coruña, CIBERCV, 15006 A Coruña, Spain
5
Department of Nuclear Medicine, Hospital Clínic de Barcelona—IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
6
Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Instituto de Salud Carlos III (ISCIII), 08193 Barcelona, Spain
7
Department of Cardiovascular Surgery, Hospital Universitario A Coruña, 15006 A Coruña, Spain
8
Heart Failure Unit, Cardiology Department, Hospital Clínic de Barcelona—IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work and share first authorship.
‡
These authors contributed equally to this work and share senior authorship.
Pathogens 2026, 15(6), 626; https://doi.org/10.3390/pathogens15060626
Submission received: 25 April 2026 / Revised: 1 June 2026 / Accepted: 6 June 2026 / Published: 11 June 2026
(This article belongs to the Section Bacterial Pathogens)
Versions Notes

Abstract

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.
Keywords: ventricular assist devices; Enterococcus; device-related infections; suppressive antimicrobial therapy; bacteremia; heart transplantation ventricular assist devices; Enterococcus; device-related infections; suppressive antimicrobial therapy; bacteremia; heart transplantation

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MDPI and ACS Style

Gay, C.; Ramos-Merino, L.; Sandoval, E.; Couto-Mallón, D.; Perissinotti, A.; García-Vieites, M.; Barge-Caballero, E.; Farrero, M.; Hernández-Meneses, M.; Crespo-Lerio, M.G. Enterococcal Infections in Left Ventricular Assist Device Recipients: Two Clinical Cases and Systematic Review. Pathogens 2026, 15, 626. https://doi.org/10.3390/pathogens15060626

AMA Style

Gay C, Ramos-Merino L, Sandoval E, Couto-Mallón D, Perissinotti A, García-Vieites M, Barge-Caballero E, Farrero M, Hernández-Meneses M, Crespo-Lerio MG. Enterococcal Infections in Left Ventricular Assist Device Recipients: Two Clinical Cases and Systematic Review. Pathogens. 2026; 15(6):626. https://doi.org/10.3390/pathogens15060626

Chicago/Turabian Style

Gay, Cristina, Lucía Ramos-Merino, Elena Sandoval, David Couto-Mallón, Andrés Perissinotti, María García-Vieites, Eduardo Barge-Caballero, Marta Farrero, Marta Hernández-Meneses, and María G. Crespo-Lerio. 2026. "Enterococcal Infections in Left Ventricular Assist Device Recipients: Two Clinical Cases and Systematic Review" Pathogens 15, no. 6: 626. https://doi.org/10.3390/pathogens15060626

APA Style

Gay, C., Ramos-Merino, L., Sandoval, E., Couto-Mallón, D., Perissinotti, A., García-Vieites, M., Barge-Caballero, E., Farrero, M., Hernández-Meneses, M., & Crespo-Lerio, M. G. (2026). Enterococcal Infections in Left Ventricular Assist Device Recipients: Two Clinical Cases and Systematic Review. Pathogens, 15(6), 626. https://doi.org/10.3390/pathogens15060626

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