Infective endocarditis after transcatheter aortic valve implantation: Contributions of a single-centre experience on incidence and associated factors. / Endocarditis infecciosa después de TAVI: aportaciones de la experiencia en un único centro sobre la incidencia y los factores asociados.

INTRODUCTION: Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is an emerging complication. There are incomplete and disparate data on its incidence. We present the experience of a single-centre of incidence, mortality and associated factors of IE after TAVI. METHODS: A retrospective observational study of IE cases in people who received a TAVI, between 06/01/2009 and 11/01/2017, in a university hospital, during a median follow-up period of 15.3months (interquartile range [IQR] 9.1-36.2). Incidence, clinical, microbiological and prognostic data, and factors associated with IE after TAVI were analysed. RESULTS: Eleven patients with IE of 200 TAVI were detected. Global incidence: 5.5% (2.77 cases per 100 patient-year). The median of days from TAVI to IE was 112 (IQR 36-578), the in-hospital mortality rate was 36.4%, and the one-year mortality rate was 54.5%. All the organisms identified were gram-positive (4 Enterococcus faecalis, 3 coagulase-negative Staphylococcus). The patients with IE after TAVI were significantly younger (median 78years, IQR 73-80, versus 82 years, IQR 79-84, P=.002), they had a higher EuroSCORE (5.1±2.4 versus 3.2±1.2, P<.001), and they more frequently had a history of neoplasia (18.2% versus 4.2%, P<.03) CONCLUSIONS: In our area, IE after TAVI has an incidence greater than that described in multicentre series, this is in line with the trend published in the literature. It leads to high mortality and is associated with a worse baseline clinical situation.

Infecciones por enterobacterias productoras de betalactamasas de espectro extendido tras cirugía cardiaca: su impacto en la mortalidad / Extended-spectrum beta-lactamase-producing Enterobacteriaceae infections after cardiac surgery: their impact on mortality

Introducción: Las enterobacterias productoras de betalactamasas de espectro extendido (EP BLEE) causan infecciones nosocomiales de modo creciente. Es controvertido si se asocian a peor pronóstico. El objetivo de este trabajo fue analizar si las infecciones por EP BLEE tras cirugía cardiaca presentan peor pronóstico que las causadas por enterobacterias no multirresistentes. Material y método: Estudio retrospectivo de las infecciones postquirúrgicas por enterobacterias, diagnosticadas en el Servicio de Cirugía Cardiaca de un Hospital Universitario (1/12/2007-1/12/2012). Se analizó la presencia de BLEE, la idoneidad del tratamiento empírico y la mortalidad global y relacionada. Resultados: Se analizaron 61 pacientes (67,2 ± 10 años). En 16 (26,2%) se aislaron EP BLEE. Las especies más frecuentes fueron Escherichia coli (20 casos/9 BLEE), Enterobacter spp (18/1), Serratia marcescens (11/3), Proteus mirabilis (11/1) y Klebsiella spp (9/2). Las localizaciones más frecuentes fueron la sangre (54,1%), las vías respiratorias (31,1%) y la herida quirúrgica (19,7%). El tratamiento empírico inicial fue no idóneo en mayor proporción en las infecciones por EP BLEE (66,7% frente a 15,9%, p < 0,0001). Fallecieron 26 pacientes (42,6%). La mortalidad global se asoció a infección por EP BLEE (odds ratio 5,3; IC 95% 1,3-21,5). La mortalidad atribuida a enterobacterias (14 pacientes) fue mayor cuando hubo bacteriemia (75% frente a 22%, p < 0,02) y el tratamiento empírico fue no idóneo (87,5% frente a 43,7%, p = 0,05). Conclusiones: La infección por EP BLEE en la post-cirugía cardiaca puede asociarse a mayor mortalidad, especialmente cuando hay bacteriemia. Ante la sospecha de infección post-quirúrgica por enterobacterias, se debe ajustar el tratamiento empírico según la incidencia local de EP BLEE.

Introduction: Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ES BLEE) increasingly cause nosocomial infections. It is controversial whether they are associated to a worse prognosis. The motivation for this study is to analyse if infections caused by ES BLEE after a cardiac surgery show a worse diagnosis that those caused by non-multidrug-resistant enterobacteriaceae. Material and methods: Retrospective study of postoperative infections caused by enterobacteriaceae, diagnosed at the Cardiac Surgery Department (1/12/2007-1/12/2012). The presence of BLEE, the adequacy of the empirical treatment and global and related mortality were analysed. Results: 61 patients were analysed (67.2 ± 10 years). In 16 (26.2%) ES BLEE were found. Most commonly found species were Escherichia coli (20 cases/9 BLEE), Enterobacter spp (18/1), Serratia marcescens (11/3), Proteus mirabilis (11/1) and Klebsiella spp (9/2). Most frequent locations were blood (54.1%), respiratory tract (31.1%) and surgical wound (19.7%). Initial empirical treatment was not adequate in greater proportion in infections for ES BLEE (66.7% versus 15.9%, p < 0,0001). 26 patients died (42.6%). Global mortality was associated to an ES BLEE infection (odds ratio 5.3; CI 95% 1.3-21.5). Mortality attributed to enterobacteriaceae (14 patients) was higher when bacteremia was present (75% versus 22%, p < 0,02) and empirical treatment was not adequate (87.5% versus 43.7%, p = 0,05). Conclusions: Infections caused by ES BLEE in the cardiac postoperative period can be associated to higher mortality, especially when there is bacteremia. In suspicion of postoperative enterobacteriaceae infection, empirical treatment must be adjusted according to the local incidence of ES BLEE

Activity of vancomycin, ciprofloxacin, daptomycin, and linezolid against coagulase-negative staphylococci bacteremia.

OBJECTIVE: Multiresistant coagulase-negative staphylococci (CNS) infections are mainly increased in hospitalized patients. We have studied the activity of vancomycin, ciprofloxacin, daptomycin and linezolid in methicillin-resistant CNS strains, isolated from true blood cultures. METHODS: We collected 87 strains of different CNS species from positive blood cultures. Staphylococci were identified by MicroScan Walkaway (Dade Behring, Siemens) and with the Api ID 32 Staph (BioMerieux, France). The susceptibility to oxacillin, vancomycin and ciprofloxacin was performed by automatic microdilution plate as cited above. The susceptibility to daptomycin and linezolid was performed by Etest (AB BioMerieux, Solna, Sweden). Interpretative criteria were done following the CLSI guidelines. RESULTS: Eighty-seven CNS strains were studied: 55 (63%) were S. epidermidis, 15 (17%) S. haemolyticus, 10 (12%) S. hominis, and 7 (8%) other species. Fifty-three (61%) strains showed loss of susceptibility to vancomycin, MIC = 2 mg/L. Ciprofloxacin resistance, MIC > 2 mg/L, was observed in 56 (64%) strains. Daptomycin resistance was not observed, with a susceptibility range between 0.032-1 mg/L and modal value of 0.25 mg/L. Ten strains (11.5%) resistant to linezolid were observed. Nine patients were in ICU, where the average length of stay was 38 days (range 16-58 days) and one belonged to Hepato-Pancreatic Surgery, where he stayed for 64 days. CONCLUSIONS: Low susceptibility to vancomycin is frequent in the CNS strains studied in our hospital. Daptomycin shows a high efficacy against CNS, and it could be useful for the treatment of primary bacteremia or catheter associated bacteremia. The massive and continuous use of linezolid has led to the appearance of resistance.