Nasal colonization with Staphylococcus aureus is a risk factor for ventricular assist device infection in the first year after implantation: A prospective, single-centre, cohort study - 14/04/20
Highlights |
• | S. aureus was the most common cause of ventricular-assist-device (VAD) infections. |
• | Nasal colonization increased the risk of S. aureus-VAD-infection about 4-fold. |
• | All VAD-infections occurred at least 7 weeks after implantation. |
• | Genotyping showed that 75% of infecting S. aureus was from endogenous origin. |
• | Sustained interruption of endogenous transmission may half burden of VAD-infections. |
Summary |
Objectives |
To assess, whether S. aureus nasal colonization is a risk factor for infections in patients with durable ventricular assist device (VAD).
Methods |
Prospective, single-centre, cohort study (i) ascertaining S. aureus nasal colonization status of patients admitted for VAD-implantation and detecting time to first episode of VAD-specific or -related infection according to International Society for Heart and Lung Transplantation criteria during follow-up and (ii) comparing whole genomes of S. aureus from baseline colonization and later infection.
Results |
Among 49 patients (17 colonized, 32 non-colonized), S. aureus VAD-infections occurred with long latency after implantation (inter quartile range 76–217 days), but occurred earlier (log-rank test P = 0.006) and were more common (9/17, 52.9% vs. 4/32, 12.5%, P = 0.005; incidence rates 2.81 vs. 0.61/1000 patient days; incidence rate ratio 4.65, 95% confidence interval 1.30–20.65, P = 0.009) among those nasally colonized with S. aureus before implantation. We found a similar but less pronounced effect of colonization status when analysing its effect on all types of VAD-infections (10/17, 58.8% vs. 7/32, 21.9%, P = 0.01). These findings remained robust when adjusting for potential confounders and restricting the analysis to ‘proven infections’. 75% (6/8) of paired S. aureus samples from colonization and VAD-infection showed concordant whole genomes.
Conclusions |
In patients with durable VAD, S. aureus nasal colonization is a source of endogenous infection, often occurring months after device-implantation and affecting mostly the driveline. Hygiene measures interrupting the endogenous route of transmission in VAD-patients colonized with S. aureus long-term may about half the burden of infections and require clinical scrutiny.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Keywords : (MeSH): Heart-Assist Devices, Survival Analysis, Risk Factors, Infection Control, Heart Failure, Cardiovascular Surgical Procedures, Methicillin-Resistant Staphylococcus aureus, Microbiota, Cohort Studies, Whole Genome Sequencing
Plan
Vol 80 - N° 5
P. 511-518 - mai 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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