Prevalence of enterococcal groin colonization in patients undergoing cardiac interventions: Challenging antimicrobial prophylaxis with cephalosporins in TAVR patients.

Widmer, David; Widmer, Andreas F; Jeger, Raban; Dangel, Marc; Stortecky, Stefan; Frei, Reno; Conen, Anna (2022). Prevalence of enterococcal groin colonization in patients undergoing cardiac interventions: Challenging antimicrobial prophylaxis with cephalosporins in TAVR patients. The journal of hospital infection, 129, pp. 198-202. Elsevier 10.1016/j.jhin.2022.07.020

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BACKGROUND

Cephalosporins are recommended for prophylaxis before transcatheter aortic valve replacement (TAVR). Infective endocarditis (IE) after TAVR is caused by enterococci in up to 30%, especially early after TAVR. Enterococcal colonization in the groin has been postulated as a source of infection, not only because prophylaxis is not covering enterococci but also because most TAVR are performed by transfemoral access. There are few data analysing the groin microbiome to demonstrate the presence of enterococci.

AIM

To assess prevalence of enterococci in groins of cardiological patients receiving transfemoral interventions.

METHODS

Prospective cohort study at the University Hospital Basel, Switzerland, between February and August 2020. From consecutive patients with transfemoral cardiac interventions two skin swabs from the groin were taken before antibiotic prophylaxis was administered: each one before/after groin disinfection. Swabs were analysed in the local microbiological laboratory following validated culture methods.

FINDINGS

Of 290 included patients, 245 (84.5%) received coronary angiography, 31 (10.7%) TAVR, eight (2.8%) right heart catheterization, five (1.7%) closure of patent foramen ovale, one (0.3%) MitraClip®. In 48 patients, enterococci were detected before disinfection, in three, enterococci were still cultured after disinfection, and in one enterococci were only detected after disinfection. Enterococcal prevalence was 16.6% before and 1.4% after disinfection. Patients colonized with enterococci had a significantly higher body mass index and more often were diabetic.

CONCLUSION

Common enterococcal colonization of the groin coupled with frequently isolated enterococci from patients with TAVR-associated IE provide strong evidence to replace currently recommended antimicrobial prophylaxis with cephalosporins before TAVR with a compound that is active against enterococci.

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