Association of preoperative infections, nasal Staphylococcus aureus colonization and gut microbiota with left ventricular assist device outcomes.

Autor: Yuzefpolskaya M; Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA., Lumish HS; Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA., Javaid A; Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA., Cagliostro B; Division of Cardiac Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA., Mondellini GM; Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA., Bohn B; Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA., Sweat A; Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA., Onat D; Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA., Braghieri L; Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA., Takeda K; Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA., Naka Y; Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA., Sayer GT; Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA., Uriel N; Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA., Aaron JG; Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA., Montassier E; Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, USA.; Université de Nantes, Microbiotas Hosts Antibiotics and Bacterial Resistances (MiHAR), and Department of Emergency Medicine, CHU de Nantes, Nantes, France., Demmer RT; Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.; Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA., Colombo PC; Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
Jazyk: angličtina
Zdroj: European journal of heart failure [Eur J Heart Fail] 2021 Aug; Vol. 23 (8), pp. 1404-1415. Date of Electronic Publication: 2021 May 31.
DOI: 10.1002/ejhf.2215
Abstrakt: Aims: Infections are common following left ventricular assist device (LVAD) implantation and predict adverse events. Infections are frequent prior to LVAD implantation although their impact on postoperative outcomes remains unknown. Gut and nasal microbial imbalance may predispose to mucosal colonization with pathogens. Herein, we investigated the predictive role of pre-LVAD infections, and explored the association of nasal Staphylococcus aureus (SA) colonization and gut microbiota, on postoperative outcomes.
Methods and Results: Overall, 254 LVAD patients were retrospectively categorized based on pre-LVAD infection status: Group 1, bacterial/fungal bloodstream infection (BSI); Group 2, other bacterial/fungal; Group 3, viral; and Group 4, no infection. In a subset of patients, nasal SA colonization (n = 140) and pre-LVAD stool (n = 25) were analysed using 16S rRNA sequencing. A total of 75 (29%) patients had a pre-LVAD infection [Group 1: 22 (29%); Group 2: 41 (55%); Group 3: 12 (16%)]. Pre-LVAD BSIs were independent predictors of 1-year postoperative mortality and infections [Group 1 vs. 4: hazard ratio (HR) 2.70, P = 0.036 vs. HR 1.8, P = 0.046]. In an unadjusted analysis, pre-LVAD infections other than BSIs, INTERMACS profile ≤2, higher serum creatinine, lower serum albumin and nasal SA colonization were also significantly associated with postoperative infections. Patients with early post-LVAD infections exhibited decreased microbial diversity (P < 0.05).
Conclusions: Pre-LVAD infections are common. BSIs independently predict postoperative mortality and infections. Additional studies are needed to confirm our findings that pre-LVAD SA nasal colonization and gut microbial composition can help stratify patients' risk for infectious complications after LVAD implantation.
(© 2021 European Society of Cardiology.)
Databáze: MEDLINE
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