Risk factors for early onset prosthetic valve endocarditis: a case–control study

Garrido, Rafael Quaresma; Pessanha, B.; Andrade, Nathália L; Correia, Marcelo; Weksler, Clara; Golebiovski, W.; Barbosa, Giovanna Ferraiuoli; Garrido, Marianne M.; Martins, Ianick Souto; Lamas, Cristiane da Cruz

doi:10.1016/j.jhin.2018.07.013

Cited by 10 publications

(10 citation statements)

References 27 publications

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“…The incidence of PVE in the aortic position (29 patients, 80.56%) was higher than in the mitral position (7 patients, 19.44%). Our results show that the incidence of PVE is similar to that reported by other studies [1,2,[6][7][8][9].…”

Section: Discussionsupporting

confidence: 91%

“…The low number of patients with PVE after mitral valve replacement may contribute to this finding. In contrast, data from other authors showed no difference in the incidence of PVE according the valve position, or reported that the aortic position is more prone to infection [5][6][7][8]25].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, infection with S. aureus is the leading cause of PVE in most epidemiologic studies and represents a high-risk subgroup in this population [25,26]. On the other hand, other authors reported S. epidermidis as the most frequent causative microorganism [7,27].…”

Section: Discussionmentioning

confidence: 99%

“…It is more important to determine whether IE was acquired perioperatively and which microorganism is involved [3]. Some risk factors appear more frequently, such as a recent episode of infectious endocarditis, postoperative blood-stream infection and surgical wound infection [7]. However, others are not well defined in the literature and results between different series vary.…”

Section: Introductionmentioning

confidence: 99%

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Valve-related factors and incidence of prosthetic valve endocarditis

Bezak

Artemiou

Hulman

2020

kitp

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Aim The aim of the study was to present our experience and evaluate the valve-related factors and the incidence of prosthetic valve endocarditis. Material and methods This is a retrospective study. Between 2010 and 2018, 36 patients were re-operated on due to prosthetic valve endocarditis The valve-related factors (type, size and position of the prosthetic valve) were analysed. Results Thirty-six patients had prosthetic valve endocarditis. The overall hospital mortality was 16.67%. Early vs. late onset prosthetic valve endocarditis mortality was 23.08% vs. 13.04% respectively. The type, size or position of the prosthesis was not associated with prosthetic valve endocarditis. There was a statistically significant difference between occurrence of prosthetic infection between mitral repair and replacement both in mechanical and biological valve groups. The most common infective agent in the early onset group was Staphylococcus aureus, whereas in the late onset group it was Enterococcus faecalis. Out of 13 patients with early prosthetic valve endocarditis, 11 had infection in the perioperative period around primary operation. Conclusions Based on our experience, prosthetic valve endocarditis has a high mortality. Early onset prosthetic valve endocarditis is less common but has higher mortality compared to the late onset. Mitral valve repair was less prone to develop prosthetic valve endocarditis, and valve-related factors (type and size of the valve, valve position) did not have any influence on the incidence of prosthetic valve endocarditis.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Valve-related factors and incidence of prosthetic valve endocarditis

Bezak

Artemiou

Hulman

2020

kitp

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“…Patients undergoing valve repair are older and have poorer health overall than the general population [ 6 ], and may therefore be at higher risk of BSI subsequent to surgery. They may also suffer increased rates of complications associated with BSI; for instance, BSI confers an increased risk of infective endocarditis (IE) in patients with a prosthetic heart valve [ 7 , 8 ]. At present few, if any, studies have examined the relationship between valve repair and subsequent BSI.…”

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confidence: 99%

Bloodstream Infection Following Cardiac Valve Repair: A Population-Based Study

McHugh

Talha

Baddour

et al. 2021

Open Forum Infectious Diseases

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Background The aim of this study was to determine the incidence, epidemiology, and associated risk factors of bloodstream infection (BSI) in patients who had previously undergone cardiac valve repair. Methods A population-based study that included 7 counties in southeastern Minnesota using the expanded Rochester Epidemiology Project (e-REP) for adults (≥18 years) who underwent valve repair between 1 January 2010 and 31 December 2018 was conducted. Electronic health records were screened for development of BSI and infective endocarditis (IE) from the date of valve repair through 30 July 2020. A 1:4 nested case-control analysis was performed to determine an association, if any, of male sex, Charlson comorbidity index (CCI), and county of residence with BSI. Results A total of 335 patients underwent valve repair, of whom 28 (8.3%) developed an index case of BSI, with 14 episodes occurring within 1 year of surgery. The median age of patients with BSI was 70 years, and 79% were male. The crude incidence of BSI was 1671 cases per 100000 person-years and Escherichia coli was the most common pathogen. Case-control analysis demonstrated a significant correlation between CCI and incidence of BSI (P < .001). Only 4 (14.3%) patients developed IE concurrent with the onset of BSI, and no patients developed IE subsequent to BSI. Conclusions The crude incidence of BSI following valve repair was higher in our e-REP cohort than previous population-based studies, and half of the BSI cases occurred within 1 year of surgery. Patients with a higher CCI at baseline were at increased risk of subsequent BSI.

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Infective endocarditis after isolated aortic valve replacement: comparison between catheter-interventional and surgical valve replacement

Ried,

Omran,

Potratz

et al. 2024

Clin Res Cardiol

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Background and aims Prosthetic valve endocarditis (PVE) is the prognostically most unfavourable complication after aortic valve replacement. This study aims to contribute to a better understanding of the different pathological and therapeutical aspects between PVE following surgical (SAVR) and transcatheter aortic valve replacement (TAVI). Methods All patients who had undergone primary isolated SAVR (n = 3447) or TAVI (n = 2269) at our Centre between 01/2012 and 12/2018 were analysed. Diagnosis of PVE was based on Duke criteria modified in 2015. Incidence, risk factors, pathogens, impact of complications or therapy on mortality were analysed and compared between SAVR- and TAVI-PVE. Results PVE incidence did not differ significantly after SAVR with 4.9/100 patient-years and TAVI with 2.4/100 patient-years (p = 0.49), although TAVI patients were older (mean 80 vs. 67 years) and had more comorbidities (STS score mean 5.9 vs. 1.6) (p < 0.001). TAVI prostheses with polymer showed a 4.3-fold higher risk to develop PVE than without polymer (HR 4.3; p = 0.004). Most common pathogens were staphylococci and enterococci (p > 0.05). Propensity-score matching analysis showed that the type of aortic valve replacement had no effect on the development of post-procedural PVE (p = 0.997). One-year survival was higher in TAVI-PVE patients treated with antibiotics only compared to additional surgical therapy (90.9% vs. 33.3%; p = 0.005). In SAVR-PVE patients, both therapies were comparable in terms of survival (p = 0.861). However, SAVR-PVE patients who were not operated, despite ESC-guideline recommendation, had significantly poorer one-year survival (p = 0.004). Conclusion TAVI patients did not have a significantly higher risk to develop PVE. Our data suggest that TAVI-PVE patients in contrast to SAVR-PVE patients can more often be treated with antibiotics only, presumably due to the lack of a polymeric suture ring. Graphical abstract Key question: What are the differences between SAVR- and TAVI-PVE? Are the current ESC guidelines for the treatment of SAVR-PVE also applicable to TAVI-PVE? Key finding: No significantly different PVE incidences after SAVR and TAVI Significantly better one-year survival and significantly longer survival in TAVI-PVE treated with antibiotics only compared with additional surgical therapy Higher risk to develop PVE after TAVI in patients carrying prostheses containing polymer particles Take-home message TAVI-PVE can often be treated successfully with antibiotics-only, even if surgery would have been indicated according to current guidelines. SAVR-PVE patients benefit from surgical therapy, so guideline-compliant surgical indication should be made promptly and performed immediately

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Risk factors for early onset prosthetic valve endocarditis: a case–control study

Cited by 10 publications

References 27 publications

Valve-related factors and incidence of prosthetic valve endocarditis

Valve-related factors and incidence of prosthetic valve endocarditis

Bloodstream Infection Following Cardiac Valve Repair: A Population-Based Study

Infective endocarditis after isolated aortic valve replacement: comparison between catheter-interventional and surgical valve replacement

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