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Patient Characteristics, Microbiology, and Mortality of Infective Endocarditis After Transcatheter Aortic Valve Implantation.
Strange, Jarl Emanuel; Østergaard, Lauge; Køber, Lars; Bundgaard, Henning; Iversen, Kasper; Voldstedlund, Marianne; Gislason, Gunnar Hilmar; Olesen, Jonas Bjerring; Fosbøl, Emil Loldrup.
Afiliação
  • Strange JE; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
  • Østergaard L; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark.
  • Køber L; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
  • Bundgaard H; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
  • Iversen K; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
  • Voldstedlund M; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark.
  • Gislason GH; Statens Serum Institut, Copenhagen, Denmark.
  • Olesen JB; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark.
  • Fosbøl EL; The Danish Heart Foundation, Copenhagen, Denmark.
Clin Infect Dis ; 77(12): 1617-1625, 2023 12 15.
Article em En | MEDLINE | ID: mdl-37470442
ABSTRACT

BACKGROUND:

Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is associated with high mortality and surgery is rarely performed. Thus, to inform on preventive measures and treatment strategies, we investigated patient characteristics and microbiology of IE after TAVI.

METHODS:

Using Danish nationwide registries, we identified patients with IE after TAVI, IE after non-TAVI prosthetic valve (nTPV), and native valve IE. Patient characteristics; overall, early (≤12 m), and late IE (>12 m) microbiology; and unadjusted and adjusted mortality were compared.

RESULTS:

We identified 273, 1022, and 5376 cases of IE after TAVI, IE after nTPV, and native valve IE. Age and frailty were highest among TAVI IE (4.8%; median age 82 y; 61.9% frail). Enterococcus spp. were common for IE after TAVI (27.1%) and IE after nTPV (21.2%) compared with native valve IE (11.4%). Blood culture-negative IE was rare in IE after TAVI (5.5%) compared with IE after nTPV (15.2%) and native valve IE (13.5%). The unadjusted 90-day mortality was comparable, but the 5-year mortality was highest for IE after TAVI (75.2% vs 57.2% vs 53.6%). In Cox models adjusted for patient characteristics and bacterial etiology for 1-90 days and 91-365 days, there was no significant difference in mortality rates.

CONCLUSIONS:

Patients with IE after TAVI are older and frailer, enterococci and streptococci are often the etiologic agents, and are rarely blood culture negative compared with other IE patients. Future studies regarding antibiotic prophylaxis strategies covering enterococci should be considered in this setting.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Próteses Valvulares Cardíacas / Infecções Relacionadas à Prótese / Endocardite / Endocardite Bacteriana / Substituição da Valva Aórtica Transcateter Tipo de estudo: Prognostic_studies Limite: Aged80 / Humans Idioma: En Revista: Clin Infect Dis Assunto da revista: DOENCAS TRANSMISSIVEIS Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Dinamarca

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Próteses Valvulares Cardíacas / Infecções Relacionadas à Prótese / Endocardite / Endocardite Bacteriana / Substituição da Valva Aórtica Transcateter Tipo de estudo: Prognostic_studies Limite: Aged80 / Humans Idioma: En Revista: Clin Infect Dis Assunto da revista: DOENCAS TRANSMISSIVEIS Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Dinamarca