Dataset Information

Patient characteristics, microbiology, and mortality of infective endocarditis after transcatheter aortic valve implantation.

ABSTRACT:

Background

Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is associated with a high mortality and surgery is rarely performed. Thus, to inform on preventive measures and treatment strategies, we investigated patient characteristics and microbiology of IE after TAVI.

Methods

Using Danish nationwide registries, we identified patients with IE after TAVI, IE after non-TAVI prosthetic valve (nTPV), and native valve IE. Patient characteristics; overall, early (≤12 month), and late IE (>12 month) microbiology; and unadjusted and adjusted mortality were compared.

Results

We identified 273, 1022, and 5376 cases of IE after TAVI, IE after nTPV and native valve IE. Age and frailty were highest among TAVI IE (4.8%; median age 82 years; 61.9% frail). Enterococcus spp. was common for IE after TAVI (27.1%) and IE after nTPV (21.2%) compared with native valve IE (11.4%). Blood culture negative IE was rare IE after TAVI (5.5%) compared with IE after nTPV (15.2%) and native valve IE (13.5%). The unadjusted 90-day mortality was comparable, but the 5-year mortality was highest for IE after TAVI (75.2% vs. 57.2% vs. 53.6%). In 1-90 days and 91-365 days Cox models adjusted for patient characteristics and bacterial etiology there was no significant difference in mortality rates.

Conclusion

Patients with IE after TAVI are older and frailer, enterococci and streptococci are often the aetiologic agents, and rarely blood culture negative compared with other IE patients. Future studies regarding antibiotic prophylaxis strategies covering enterococci should be considered in this setting.

SUBMITTER: Strange JE

PROVIDER: S-EPMC10724461 | biostudies-literature | 2023 Jul

REPOSITORIES: biostudies-literature

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Publications

Patient Characteristics, Microbiology, and Mortality of Infective Endocarditis After Transcatheter Aortic Valve Implantation.

Strange Jarl Emanuel JE Østergaard Lauge L Køber Lars L Bundgaard Henning H Iversen Kasper K Voldstedlund Marianne M Gislason Gunnar Hilmar GH Olesen Jonas Bjerring JB Fosbøl Emil Loldrup EL

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 20231201 12

<h4>Background</h4>Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is associated with high mortality and surgery is rarely performed. Thus, to inform on preventive measures and treatment strategies, we investigated patient characteristics and microbiology of IE after TAVI.<h4>Methods</h4>Using Danish nationwide registries, we identified patients with IE after TAVI, IE after non-TAVI prosthetic valve (nTPV), and native valve IE. Patient characteristics; overall, e ...[more]

PMID: 37470442

Similar Datasets

Project description:BACKGROUND:The data on infective endocarditis after transcatheter aortic valve implantation (TAVI) is scarce and limited to case reports and case series in the literature. It is the need of the hour to analyze the available data on post-TAVI infective endocarditis from the available literature. The objectives of this systematic review were to evaluate the incidence of infective endocarditis after transcatheter aortic valve implantation, its microbiological profile and clinical outcomes. It will help us to improve the antibiotic prophylaxis strategies and treatment options for infective endocarditis in the context of TAVI. METHODS:EMBASE, Medline and the CENTRAL trials registry of the Cochrane Collaboration were searched for articles on infective endocarditis in post-TAVI patients till October 2018. Eleven articles were included in the systematic review. The outcomes assessed werethe incidence of infective endocarditis, its microbiological profile andclinical outcomes including major adverse cardiac event (MACE), net adverse clinical event (NACE), surgical intervention and valve-in-valve procedure. RESULTS:The incidence of infective endocarditis varied from 0%-14.3% in the included studies, the mean was3.25%. The average duration of follow-up was 474 days (1.3 years). Enterococci were the most common causative organism isolated from 25.9% of cases followed by Staphylococcus aureus (16.1%) and coagulase-negative Staphylococcus species (14.7%). The mean in-hospital mortality and mortality at follow-up was 29.5% and 29.9%, respectively. The cumulative incidence of heart failure, stroke and major bleeding were 37.1%, 5.3% and 11.3%,respectively. Only a single study by Martinez-Selles et al. reported arrhythmias in 20% cases. The septic shock occurred in 10% and 27.7% post-TAVI infective endocarditis patients according to 2 studies. The surgical intervention and valve-in-valve procedure were reported in 11.4% and 6.4% cases, respectively. CONCLUSION:The incidence of post-TAVI infective endocarditis is low being 3.25% but it is associated with high mortality and complications. The most common complication is heart failure with a cumulative incidence of 37.1%. Enterococciare the most common causative organism isolated from 25.9% of cases followed by Staphylococcus aureus in 16.1% of cases. Appropriate measures should be taken to prevent infective endocarditis in post-TAVI patients including adequate antibiotics prophylaxis directed specifically against these organisms. STUDY REGISTRATION:PROSPERO registration number CRD42018115943.