In-hospital infective endocarditis following transcatheter aortic valve replacement: a cross-sectional study of the National Inpatient Sample database in the USA

I. Yeo, L. K. Kim, S. O. Park, S. C. Wong

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Background: While the utilization of transcatheter aortic valve replacement (TAVR) for patients with severe aortic stenosis has been increasing, in-hospital infective endocarditis (IE) following TAVR has not been well described. Aim: To identify in-hospital IE following TAVR. Methods: All patients who underwent TAVR between 2012 and 2014 were identified using the National Inpatient Sample database. Multi-variate logistic regression was performed to identify the predictors of in-hospital IE after TAVR. Findings: Of the 41,025 patients who received TAVR, 120 patients (0.3%) developed in-hospital IE. Viridans group streptococci (20.8%) was the most frequent causative organism for in-hospital IE, followed by Staphylococcus aureus (16.7%) and enterococci (8.3%). Patients who developed in-hospital IE after TAVR had significantly higher rates of death (20.8% vs 4.1%, P<0.001), septic shock (16.7% vs 0.8%, P<0.001), cardiogenic shock (12.5% vs 3.4%, P=0.02), acute kidney injury requiring haemodialysis (16.7% vs 1.6%, P<0.001), bleeding requiring transfusion (29.2% vs 11.3%, P=0.01), myocardial infarction (12.5% vs 2.1%, P<0.001) and permanent pacemaker removal (4.2% vs 0.05%, P<0.001) compared with patients without IE. Independent predictors of in-hospital IE after TAVR include younger age [odds ratio (OR) 0.92, 95% confidence interval (CI) 0.89–0.95], drug abuse (OR 48.9, 95% CI 6.9–347.3) and human immunodeficiency virus (HIV) infection (OR 7.8, 95% CI 1.4–44.4). Conclusion: IE occurred in 0.3% of patients after TAVR during the same hospitalization, resulting in higher rates of adverse outcomes including mortality. Patients with younger age, a history of drug abuse or HIV infection are at greater risk of in-hospital IE following TAVR, and would benefit from vigilant preventive measures perioperatively.

Original languageEnglish (US)
Pages (from-to)444-450
Number of pages7
JournalJournal of Hospital Infection
Volume100
Issue number4
DOIs
StatePublished - Dec 2018

Keywords

  • Aortic stenosis
  • In-hospital infective endocarditis
  • Transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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