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Infective endocarditis confers poor outcomes after TAVR
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Among patients who had transcatheter aortic valve replacement, infective endocarditis was linked to elevated risk for mortality and stroke, researchers reported.
The researchers analyzed 7,203 patients from the SwissTAVI registry who underwent TAVR between February 2011 and July 2018.
During follow-up of 14,832 patient-years, 149 patients were diagnosed with effective endocarditis, Stefan Stortecky, MD, interventional cardiologist at Bern University Hospital (Inselspital), Switzerland, and colleagues found.
The incidence rate for periprocedural infective endocarditis (less than 100 days) was 2.59 events per 100 person-years, whereas it was 0.71 events per 100 person-years for delayed-early infective endocarditis (100 days to 1 year) and 0.4 events per 100 person-years for late infective endocarditis (more than 1 year), according to the researchers.
In those with early endocarditis, the most common pathogen was Enterococcus species (30.1%), whereas in those with periprocedural endocarditis, 47.9% had a pathogen that could not be addressed by antibiotic prophylaxis, Stortecky and colleagues wrote.
The researchers identified the following independent predictors of infective endocarditis:
- younger age (subhazard ratio (SHR) = 0.969; 95% CI, 0.944-0.994);
- male sex (SHR = 1.989; 95% CI, 1.403-2.818);
- lack of predilatation (SHR = 1.485; 95% CI, 1.065-2.069); and
- treatment in a cath lab instead of a hybrid operating room (SHR = 1.648; 95% CI, 1.187-2.287).
When the researchers performed a case-control matched analysis, they found that compared with those who did not develop infective endocarditis, those who did had elevated risk for mortality (HR = 6.55; 95% CI, 4.44-9.67) and stroke (HR = 4.03; 95% CI, 1.54-10.52).
“Future studies need to address whether changes in antibiotic prophylaxis; treatment in a hybrid OR setting; and other measures, such as improved disinfection, hygiene of the femoral skin or other preventive hygiene measures are able to decrease the levels of bacterial contamination and, as a result, infective endocarditis,” the researchers wrote.
In a related editorial, Bernard D. Prendergast, BMBS, MD, consultant cardiologist at St. Thomas’ Hospital, London, and colleagues wrote that the study should “prompt each center to review whether antibiotic prophylaxis regimens at the time of implantation have sufficient coverage against local isolates of enterococci. Given that enterococci most commonly arise from the gastrointestinal or genitourinary tract, it seems logical that urinary catheterization should be avoided if at all possible, with consideration given to prophylactic antibiotics, if required.