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Aortic and vascular disease
Original research
Bacteraemia after transcatheter aortic valve implantation: a nationwide cohort study
  1. Katra Hadji-Turdeghal1,
  2. Jeppe K Petersen1,
  3. Peter Laursen Graversen1,
  4. Jawad Haider Butt1,2,
  5. Jarl Emanuel Strange1,3,
  6. Nikolaj Ihlemann4,
  7. Jordi Sanchez Dahl5,
  8. Jonas Agerlund Povlsen6,
  9. Marianne Voldstedlund7,
  10. Christian Juhl Terkelsen6,
  11. Christian H Møller8,
  12. Philip Freeman9,
  13. Henrik Nissen5,
  14. Ole De Backer1,
  15. Lars Koeber1,
  16. Lauge Østergaard1,
  17. Emil Loldrup Fosbøl1
  1. 1 Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
  2. 2 Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
  3. 3 Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Hellerup, Denmark
  4. 4 Department of Cardiology, Copenhagen University Hospital - Bispebjerg Hospital, Copenhagen, Denmark
  5. 5 Department of Cardiology, Odense University Hospital, Odense, Denmark
  6. 6 Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
  7. 7 Department of Data Integration and Analysis, Statens Serum Institut, Copenhagen, Denmark
  8. 8 Department of Cardiothoracic Surgery, University of Copenhagen - Rigshospitalet, Copenhagen, Denmark
  9. 9 Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
  1. Correspondence to Dr Katra Hadji-Turdeghal; katra.hadji-turdeghal{at}regionh.dk

Abstract

Background Bacteraemia and infective endocarditis (IE) are rare but severe complications of transcatheter aortic valve implantation (TAVI). Limited data exist on the incidence and microbiological profile of early bacteraemia in this population. This study aimed to evaluate the 6-month incidence of bacteraemia, IE and associated mortality following TAVI.

Methods Using Danish nationwide registries, all patients who underwent TAVI from 2012 to 2021 were identified and matched 1:1 by age, sex and index year with patients who underwent elective coronary angiography (CAG). Outcomes were assessed with cumulative incidence functions and adjusted HRs.

Results Among 5990 patients with first-time TAVI (57% male, mean age 80 years, SD 6.9), bacteraemia occurred in 4.2% within 6 months, compared with 2.6% in the CAG group (adjusted HR 1.57, 95% CI 1.26 to 1.96). Common pathogens post-TAVI included Streptococci (20%), Coagulase-negative staphylococci (19%) and Enterococci (18%), differing from the CAG group, where Coagulase-negative staphylococci (22%) and Staphylococcus aureus (16%) predominated. IE developed in 1.1% of patients with TAVI versus 0.1% of patients with CAG (adjusted HR 20.01, 95% CI 5.97 to 67.48).

Conclusion Bacteraemia and IE rates are substantially elevated within 6 months following TAVI compared with elective CAG. The bacterial profile post-TAVI suggests that current prophylactic antibiotic regimens may not provide adequate coverage.

  • transcatheter aortic valve replacement
  • epidemiology
  • endocarditis
  • aortic valve stenosis

Data availability statement

No data are available.

https://doi.org/10.1136/heartjnl-2024-324803

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    Data availability statement

    No data are available.

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    Footnotes

    • Contributors KH-T: data acquisition, data analysis, data interpretation, data management, planning, conducting and reporting this study, writing, editing and submitting the manuscript. JKP, PLG, JHB, LØ: aided with data acquisition, data analysis, data interpretation and critical revision of the manuscript. JES, NI, JSD, JAP, MV, CJT, CHM, PF, HN, ODB, LK: aided with data analysis, data interpretation and critical revision of the manuscript. ELF: conception, conducting and the design of the work, planning, and reporting this study, data analysis, data interpretation, critical revision of the article, and general supervision throughout the process. KH-T and ELF are responsible for the overall content and the final approval of the version to be published as the guarantors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests JHB: reports advisory board honoraria from AstraZeneca and Bayer; consultant honoraria from Novartis and AstraZeneca; travel grants from AstraZeneca. CJT: research grants from Edward, Meril, Terumo. Proctor fee from Edwards and Meril. Research grants from The Danish Heart Foundation. Independent research grant related to valvular heart disease unrelated to this manuscript. LK: has received lecture fees from AstraZeneca, Bayer, Boehringer, Novartis and Novo, unrelated to this manuscript. LØ: an independent research grant from the Novo Nordisk Foundation for the study of mitral regurgitation, unrelated to this manuscript. ELF: independent research grants from the Novo Nordisk Foundation and the Danish Heart Association, related to valvular heart disease and endocarditis, unrelated to this manuscript. KH-T, JKP, PLG, JES, NI, JSD, JAP, MV, CHM, PF, HN, ODB: none.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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