Canada: A recent study in the Canadian Journal of Cardiology showed that Staphylococcus aureus (SA) infective endocarditis (IE) represents 25% of IE cases after TAVR and is tied to very high in-hospital and late mortality. The presence of some features determined a higher possibility of SA IE and could help to align the selection of an early antibiotic regimen.
SA has been studied extensively as a causative microorganism of surgical prosthetic-valve IE. However, there is not much evidence on SA IE after transcatheter aortic valve replacement (TAVR). To fill this knowledge gap, Josep Rodés-Cabau, Québec Heart & Lung Institute, Laval University, Québec City, Québec, Canada, and colleagues aimed to evaluate the clinical characteristics, management, and in-hospital and late outcomes of patients with SA IE after TAVR.
For this purpose, the researchers obtained data from the Infectious Endocarditis After TAVR International Registry that included patients with definite IE after TAVR from 59 centers in 11 countries. According to microbiologic etiology patients were divided into 2 groups: non-SA IE vs SA IE.
Following were the study's main findings:
About 25% of cases of IE after TAVR had SA as a causative microorganism.
Patients with SA IE presented TAVR-related complications (acute renal failure, stroke, major bleeding, and sepsis) more frequently and had longer intensive unit care hospitalizations after TAVR.
Periprocedural TAVR major bleeding or sepsis, neurologic symptoms or systemic embolisms at admission, and IE with signs of cardiac device involvement (other than the TAVR prosthesis) were associated with SA IE, and the presence of such factors (particularly in combination) at the index IE hospitalization determined a high likelihood of SA IE (> 80% in patients with -3 factors).
SA IE was associated with a higher incidence of IE-related complications (compared with non-SAIE) and a very high in-hospital (close to 50%) and follow-up (> 70% at 2 years) mortality rates.
The lack of surgical management at index IE hospitalization among SA IE patients determined an increased mortality risk.
"Surgery at index SA IE was associated with improved outcomes, and its role should be evaluated in future studies," the authors wrote.
Reference:
The study titled, "Infective Endocarditis Caused by Staphylococcus aureus After Transcatheter Aortic Valve Replacement," was published in the Canadian Journal of Cardiology.
DOI: https://doi.org/10.1016/j.cjca.2021.10.004