Infective Endocarditis Caused by Staphylococcus aureus After Transcatheter Aortic Valve Replacement.

Val, David Del; Abdel-Wahab, Mohamed; Mangner, Norman; Durand, Eric; Ihlemann, Nikolaj; Urena, Marina; Pellegrini, Costanza; Giannini, Francesco; Gasior, Tomasz; Wojakowski, Wojtek; Landt, Martin; Auffret, Vincent; Sinning, Jan Malte; Cheema, Asim N; Nombela-Franco, Luis; Chamandi, Chekrallah; Campelo-Parada, Francisco; Munoz-Garcia, Erika; Herrmann, Howard C; Testa, Luca; ... (2022). Infective Endocarditis Caused by Staphylococcus aureus After Transcatheter Aortic Valve Replacement. The Canadian journal of cardiology, 38(1), pp. 102-112. Elsevier 10.1016/j.cjca.2021.10.004

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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 S aureus in most cases (115/141, 81.6%). Self-expanding valves were more common than balloon-expandable valves in patients 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 post-TAVR patients with IE, 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 was associated with a lower mortality rate at follow-up (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.

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