Infective Endocarditis Caused by Staphylococcus aureus After Transcatheter Aortic Valve Replacement

David del Val, Mohamed Abdel-Wahab, Norman Mangner, Eric Durand, Nikolaj Ihlemann, Marina Urena, Costanza Pellegrini, Francesco Giannini, Tomasz Gasior, Wojtek Wojakowski, Martin Landt, Vincent Auffret, Jan Malte Sinning, Asim N. Cheema, Luis Nombela-Franco, Chekrallah Chamandi, Francisco Campelo-Parada, Erika Munoz-Garcia, Howard C. Herrmann, Luca TestaKim Won-Keun, Juan Carlos Castillo, Alberto Alperi, Didier Tchetche, Antonio L. Bartorelli, Samir Kapadia, Stefan Stortecky, Ignacio Amat-Santos, Harindra C. Wijeysundera, John Lisko, Enrique Gutiérrez-Ibanes, Vicenç Serra, Luisa Salido, Abdullah Alkhodair, Igor Vendramin, Tarun Chakravarty, Stamatios Lerakis, Victoria Vilalta, Ander Regueiro, Rafael Romaguera, Utz Kappert, Marco Barbanti, Jean Bernard Masson, Frédéric Maes, Claudia Fiorina, Antonio Miceli, Susheel Kodali, Henrique B. Ribeiro, Jose Armando Mangione, Fabio Sandoli de Brito, Guglielmo Mario Actis Dato, Francesco Rosato, Maria Cristina Ferreira, Valter Corriea de Lima, Alexandre Siciliano Colafranceschi, Alexandre Abizaid, Marcos Antonio Marino, Vinicius Esteves, Julio Andrea, Roger R. Godinho, Fernando Alfonso, Helene Eltchaninoff, Lars Søndergaard, Dominique Himbert, Oliver Husser, Azeem Latib, Hervé Le Breton, Clement Servoz, Isaac Pascual, Saif Siddiqui, Paolo Olivares, Rosana Hernandez-Antolin, John G. Webb, Sandro Sponga, Raj Makkar, Annapoorna S. Kini, Marouane Boukhris, Philippe Gervais, Axel Linke, Lisa Crusius, David Holzhey, Josep Rodés-Cabau

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Staphylococcus aureus (SA) has been extensively studied as causative microorganism of surgical prosthetic-valve infective endocarditis (IE). However, scarce evidence exists on SA IE after transcatheter aortic valve replacement (TAVR). Methods: Data were obtained from the Infectious Endocarditis After TAVR International Registry, including patients with definite IE after TAVR from 59 centres in 11 countries. Patients were divided into 2 groups according to microbiologic etiology: non-SA IE vs SA IE. Results: SA IE was identified in 141 patients out of 573 (24.6%), methicillin-sensitive SA in most cases (115/141, 81.6%). Self-expanding valves were more common than balloon-expandable valves in patients presenting with early SA IE. Major bleeding and sepsis complicating TAVR, neurologic symptoms or systemic embolism at admission, and IE with cardiac device involvement (other than the TAVR prosthesis) were associated with SA IE (P < 0.05 for all). Among patients with IE after TAVR, the likelihood of SA IE increased from 19% in the absence of those risk factors to 84.6% if ≥ 3 risk factors were present. In-hospital (47.8% vs 26.9%; P < 0.001) and 2-year (71.5% vs 49.6%; P < 0.001) mortality rates were higher among patients with SA IE vs non-SA IE. Surgery at the time of index SA IE episode was associated with lower mortality at follow-up compared with medical therapy alone (adjusted hazard ratio 0.46, 95% CI 0.22-0.96; P = 0.038). Conclusions: SA IE represented approximately 25% of IE cases after TAVR and was associated with very high in-hospital and late mortality. The presence of some features determined a higher likelihood of SA IE and could help to orientate early antibiotic regimen selection. Surgery at index SA IE was associated with improved outcomes, and its role should be evaluated in future studies.

Original languageEnglish (US)
Pages (from-to)102-112
Number of pages11
JournalCanadian Journal of Cardiology
Volume38
Issue number1
DOIs
StatePublished - Jan 2022

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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