Details

Autor(en) / Beteiligte

• Nurjadi, Dennis
• Last, Katharina
• Klein, Sabrina
• Boutin, Sébastien
• Schmack, Bastian
• Mueller, Florian
• Heeg, Klaus
• Ruhparwar, Arjang
• Heininger, Alexandra
• Zanger, Philipp

Titel

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

Ist Teil von

• The Journal of infection, 2020-05, Vol.80 (5), p.511-518

Ort / Verlag

England: Elsevier Ltd

Erscheinungsjahr

2020

Quelle

MEDLINE

Beschreibungen/Notizen

• •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. To assess, whether S. aureus nasal colonization is a risk factor for infections in patients with durable ventricular assist device (VAD). 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. 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. 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. [Display omitted]