Incidence, Causes, and Impact of In-Hospital Infections After Transcatheter Aortic Valve Implantation.
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 (p <0.001) were independently associated with an increased infection risk. Patients with IHI had a longer hospital stay (14 vs 6 days, p <0.001), 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.
Cardiology Department, Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain.
Gabriela
G
Tirado-Conte
Cardiology Department, Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain.
Afonso B
AB
Freitas-Ferraz
Cardiology Department, Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain. Electronic address: luisnombela@yahoo.com.
Luis
L
Nombela-Franco
Cardiology Department, Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain.
Pilar
P
Jimenez-Quevedo
Cardiology Department, Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain.
Corina
C
Biagioni
Cardiology Department, Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain.
Ana
A
Cuadrado
Cardiology Department, Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain.
Ivan
I
Nuñez-Gil
Cardiology Department, Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain.
Pablo
P
Salinas
Cardiology Department, Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain.
Nieves
N
Gonzalo
Cardiology Department, Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain.
Carlos
C
Ferrera
Cardiology Department, Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain.
David
D
Vivas
Cardiology Department, Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain.
Javier
J
Higueras
Cardiology Department, Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain.
Ana
A
Viana-Tejedor
Cardiology Department, Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain.
Maria Jose
MJ
Perez-Vizcayno
Cardiology Department, Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain.
Isidre
I
Vilacosta
Cardiology Department, Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain.
Javier
J
Escaned
Cardiology Department, Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain.
Antonio
A
Fernandez-Ortiz
Cardiology Department, Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain.
Carlos
C
Macaya
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery; D016470:Bacteremia / Q000453:epidemiology*; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009026:Mortality; D011183:Postoperative Complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012141:Respiratory Tract Infections / Q000453:epidemiology*; D012307:Risk Factors; D013530:Surgical Wound Infection; D065467:Transcatheter Aortic Valve Replacement; D014552:Urinary Tract Infections / Q000453:epidemiology*