Incidence, Causes, and Impact of In-Hospital Infections After Transcatheter Aortic Valve Implantation
| Autor: | María José Pérez-Vizcayno, Carlos Macaya, Gabriela Tirado-Conte, Pilar Jiménez-Quevedo, Pablo Salinas, Nieves Gonzalo, Javier Escaned, David Vivas, Ana Viana-Tejedor, Afonso B. Freitas-Ferraz, Isidre Vilacosta, Antonio Fernández-Ortiz, Carlos Ferrera, Iván J. Núñez-Gil, Luis Nombela-Franco, Javier Higueras, Corina Biagioni, Ana María Martín Cuadrado |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Urinary system Bacteremia 030204 cardiovascular system & hematology Transcatheter Aortic Valve Replacement 03 medical and health sciences Postoperative Complications 0302 clinical medicine Risk Factors medicine.artery Internal medicine medicine Humans Surgical Wound Infection 030212 general & internal medicine Mortality Respiratory Tract Infections Aged Proportional Hazards Models Aged 80 and over Cross Infection Aorta Respiratory tract infections business.industry Incidence Incidence (epidemiology) Aortic Valve Stenosis Length of Stay medicine.disease Surgery Stenosis Aortic valve stenosis Urinary Tract Infections Coronary care unit Cardiology Female Gram-Negative Bacterial Infections Cardiology and Cardiovascular Medicine business |
| Zdroj: | The American Journal of Cardiology. 118:403-409 |
| ISSN: | 0002-9149 |
| Popis: | In-hospital infections (IHI) are one of the most common and serious problems after invasive procedures. Transcatheter aortic valve implantation (TAVI) is an increasingly used alternative to surgery in patients with severe symptomatic aortic stenosis. The aim of this study was to determine the incidence, origin, risk factors, and clinical outcomes of IHI after TAVI. A total of 303 consecutive patients with severe aortic stenosis who underwent transfemoral TAVI were included and followed during a median time of 21 months. We examined the occurrence, types, origin, and timing of infections during hospital stay as well as short- and long-term clinical outcomes according to the occurrence of IHI. A total of 51 patients (17%; 62 infectious episodes) experienced IHI after TAVI. Respiratory and urinary tract infections were the most frequent type of infections (44% and 34%, respectively), followed by surgical site infection (8%) and bloodstream infection (5%). Positive cultures were obtained in 74% of the samples, of which 65% were gram-negative bacilli. Modifiable factors such as bleeding (p = 0.005) and length of coronary care unit stay (p0.001) were independently associated with an increased infection risk. Patients with IHI had a longer hospital stay (14 vs 6 days, p0.001), an increased mortality (hazard ratio 2.48, 95% CI 1.45 to 4.23) and readmission rate (hazard ratio 2.0, 95% CI 1.27 to 3.14) during the follow-up. In conclusion, IHI is a frequent complication after TAVI with a significant impact on short- and long-term clinical outcomes. The most important risk factors associated with the development of this complication were modifiable periprocedural aspects. These results underline the importance to implement specific preventive strategies to reduce in-hospital-acquired infections after TAVI. |
| Databáze: | OpenAIRE |
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