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Infective Endocarditis Caused by Staphylococcus Aureus after Transcatheter Aortic Valve Replacement

David Del Val 1 Mohamed Abdel-Wahab 2 Norman Mangner 2 Eric Durand 3 Nikolaj Ihlemann Marina Urena 4 Costanza Pellegrini Francesco Giannini Tomasz Gasior Wojtek Wojakowski Martin Landt Vincent Auffret 5, 6 Jan Malte Sinning Asim Cheema Luis Nombela-Franco Chekrallah Chamandi 7 Francisco Campelo-Parada 8 Erika Munoz-Garcia Howard Herrmann Luca Testa Kim Won-Keun Juan Carlos Castillo Alberto Alperi Didier Tchetche 9 Antonio Bartorelli Samir Kapadia Stefan Stortecky Ignacio Amat-Santos Harindra 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 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 Godinho Fernando Alfonso Helene Eltchaninoff 3 Lars Søndergaard Dominique Himbert Oliver Husser Azeem Latib Hervé Le Breton 5 Clement Servoz Isaac Pascual Saif Siddiqui 10 Paolo Olivares Rosana Hernandez-Antolin John Webb Sandro Sponga Raj Makkar Annapoorna Kini 11 Marouane Boukhris 12 Philippe Gervais 1 Axel Linke 13 Lisa Crusius 13 David Holzhey 13 Josep Rodés-Cabau 1, *
Abstract : Background: Staphylococcus aureus (S aureus) has been extensively studied as causative microorganism of surgical prosthetic-valve infective endocarditis (IE). However, scarce evidence exists on S aureus IE after transcatheter aortic valve replacement (TAVR). Methods: Data was obtained from the Infectious Endocarditis after TAVR International Registry including patients with definite IE following TAVR from 59 centers in 11 countries. Patients were divided into two groups according to microbiological etiology (non-S aureus-IE, non-SA-IE vs. S aureus-IE, SA-IE). Results: SA-IE was identified in 141 out of 573 (24.6%) patients, methicillin-sensitive S aureus in most cases (115/141, 81.6%). SEV were more common than BEV in patients with early SA-IE. Major bleeding and sepsis complicating TAVR, neurological 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 IE post-TAVR patients, 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 mortality (71.5% vs. 49.6%, p<0.001) rates were higher among SA-IE (vs. non-SA-IE) patients. Surgery at the time of index SA-IE was associated with a lower mortality rate at follow-up (HRadj: 0.46, 95% CI: 0.22-0.96, p=0.038). Conclusions: SA-IE represented ∼ 25% of IE cases after TAVR and was associated with a 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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Submitted on : Wednesday, November 10, 2021 - 4:14:01 PM
Last modification on : Thursday, November 11, 2021 - 3:05:22 AM

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David Del Val, Mohamed Abdel-Wahab, Norman Mangner, Eric Durand, Nikolaj Ihlemann, et al.. Infective Endocarditis Caused by Staphylococcus Aureus after Transcatheter Aortic Valve Replacement. Canadian Journal of Cardiology, Elsevier, 2021, ⟨10.1016/j.cjca.2021.10.004⟩. ⟨hal-03414486⟩

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