Pseudomonas aeruginosa Infective Endocarditis Following Transcatheter Aortic Valve Implantation: A Note of Caution

Dapás, Juan Ignacio; Rivero, Cynthia; Burgos, Pablo; Vila, Andrea

doi:10.2174/1874192401610010028

Cited by 8 publications

(9 citation statements)

References 22 publications

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“…(Amat-Santos et al, 2015;Carrel and Eberle, 2019;Martinez-Selles et al, 2016;Morioka et al, 2019;Russo et al, 2019) and 1 with Histoplasma capsulatum (Head et al, 2011). Gram-negative flora was repre- sented by 3 cases of IE with Escherichia coli (Gallouche et al, 2018;Olsen et al, 2015;Puls et al, 2013), 2 cases of Acinetobacter spp (Amat-Santos et al, 2015;Martinez-Selles et al, 2016), Pseudomonas aeruginosa (Dapas et al, 2016;Scisło et al, 2019) and 1 case of Serratia (Amat-Santos et al, 2015), Salmonella enteritidis (Martinez-Selles et al, 2016), and Moraxella nonliquefaciens (Rafiq et al, 2011). A Source of bacteremia was identified in 49.7% of the patients.…”

Section: Resultsmentioning

confidence: 98%

“…Moreover, intubation, new pacemaker implantation, and CKD were risk factors for TAVI-IE (RR: 2.99, 95% CI 2.73 to 3.28; RR: 5.19, 95% CI 4.16 to 6.47; and RR: 1.17, 95% CI 1.05 to 1.29). Other variables showed no significant statistics and are presented in Table 2. A total of 51 articles which reported individual data of 157 patients were identified, 3 observational studies (Amat-Santos et al, 2015;Olsen et al, 2015;Rodriguez-Vidigal et al, 2018), 5 case series (Aung et al, 2013;Gallouche et al, 2018;Martinez-Selles et al, 2016;Puls et al, 2013;Scisło et al, 2019), 43 case reports (Ahmad et al, 2016;Campana et al, 2019;Carnero-Alcazar et al, 2010;Carrel and Eberle, 2019;Castiglioni et al, 2012;Cho et al, 2019;Chourdakis et al, 2017;Citro et al, 2013;Comoglio et al, 2009;Dapas et al, 2016;García-Pardo et al, 2012;Gonzalez et al, 2017;Gotzmann and Mugge, 2011;Gupta et al, 2019;Gürtler et al, 2019;Halapas et al, 2014;Head et al, 2011;Kesimci et al, 2014;Lane et al, 2015;Lee et al, 2014Lee et al, , 2019Loh et al, 2013;Loverix et al, 2013;Montero-Cruces et al, 2019;Mori et al, 2019;Morioka et al, 2019;Nguyen et al, 2019;Ochiai et al, 2016;Ohori et al, 2018;…”

Section: Resultsmentioning

confidence: 99%

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Infective endocarditis after TAVI: a meta-analysis and systematic review of epidemiology, risk factors and clinical consequences

Tinică¹,

Tarus²,

Enache³

et al. 2020

Rev. Cardiovasc. Med.

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Infective endocarditis (IE) represents one of the most challenging clinical entities, requiring a multidisciplinary approach. The increasing number of surgical and transcatheter heart valves replacements performed annually lead to a higher incidence of prosthetic valve endocarditis. Transcatheter aortic valve implantation (TAVI) brought a new alternative for the treatment of aortic stenosis and a new subgroup of IE with its features. We aimed to compare the incidence of IE in TAVI and surgical valve replacement (SAVR) to identify risk factors for TAVI-IE, evaluate the possible impact on mortality, and clarify the best treatment strategies. A digital scan in PubMed and SCOPUS databases was performed. 68 publications were selected to perform a meta-analysis and systematic review on epidemiology, risk factors, and mortality predictors in TAVI-IE. No significant difference in IE rate was noted between patients with TAVI and those with SAVR for in-hospital, early, mid-term and late IE. Male gender, intubation, new pacemaker implantation IE and CKD were correlated with TAVI-IE. Surgical treatment was performed in 22.3% of cases. Overall mortality for the pooled cohort was 38.3%. In a multivariate logistic regression model, surgical treatment and self-expandable device were linked to lower mortality in TAVI-IE. Even if the invasive procedure can trigger bacteremia, exposing the TAVI valve to future infection, no significant difference in IE rate was noted in our analysis between patients with TAVI and those with SAVR for in-hospital, early, mid-term and late IE. Surgical treatment of TAVI-IE can be a viable option in patients with a prohibitive risk score.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Infective endocarditis after TAVI: a meta-analysis and systematic review of epidemiology, risk factors and clinical consequences

Tinică¹,

Tarus²,

Enache³

et al. 2020

Rev. Cardiovasc. Med.

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“…The other patient (ours) had spontaneous bacteremia. Four of the 6 patients had transfemoral TAVR, 14,16,17 1 had transsubclavian TAVR, 18 and the other patient had transapical TAVR 15 . Initial echocardiogram was negative for endocarditis in 3 patients, positive in 1 patient, and echocardiographic data were unavailable on 2 other patients.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter Aortic Valve Replacement–Associated Prosthetic Valve Endocarditis Due to Pseudomonas aeruginosa

Boylan,

Myers

2024

Infect Dis Clin Pract

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Introduction In patients unsuitable for surgical aortic valve replacement (SAVR), transcatheter aortic valve replacement (TAVR) is an alternative treatment modality for severe aortic stenosis. Prosthetic valve endocarditis (PVE) is uncommon after TAVR, and TAVR-PVE due to Pseudomonas aeruginosa is rare. We report a patient with P. aeruginosa TAVR-PVE and review the literature on the topic. Case A 70-year-old woman with history of atrial fibrillation and severe aortic stenosis status post TAVR 4 months previously presented with a third episode of P. aeruginosa bacteremia. She initially developed P. aeruginosa bacteremia 18 days after TAVR. She failed two 6-week courses of intravenous cefepime treatment and then developed P. aeruginosa breakthrough bacteremia while on her third course of intravenous cefepime. Surgical intervention was declined by the patient. Two prior transesophageal echocardiograms (TEEs) were negative for vegetation, but after her breakthrough bacteremia, a repeat TEE showed a 1.5 × 0.8-cm vegetation on the aortic valve. Patient and family declined further therapy and transitioned to hospice and died 5 days later. Discussion This is the sixth reported case of P. aeruginosa TAVR-PVE. Enterococcus faecalis, coagulase-negative Staphylococcus and Staphylococcus aureus, and streptococci are the most common etiologic agents causing TAVR-PVE. Diagnosis is difficult, and TEE may be nondiagnostic. Of the 6 reported cases, the only 2 to survive underwent SAVR despite high Society of Thoracic Surgery risk calculator scores. Conclusion TAVR-PVE due to P. aeruginosa is rare and will likely not be cured by medical therapy alone. Surgical intervention with SAVR should be considered as the only available curative therapy despite high Society of Thoracic Surgery surgical risk scores.

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“…The most common microorganisms known to cause TAVR-IE are gram-positive cocci, which include Staphylococcus aureus, coagulase negative staphylococci, and enterococci [ 1 – 3 , 6 , 16 – 18 ]. Streptococcus has also been reported to be an important cause of TAVR-IE [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Other reported causal organisms associated with TAVR related IE include gram negative rods: E. coli [ 16 , 17 , 20 ], acinetobacter [ 2 , 21 ] pseudomonas aeruginosa [ 18 , 22 ], serratia [ 2 ], and salmonella [ 21 ]. Our patients both had MSSA bacteremia.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter aortic valve replacement associated infective endocarditis case series: broadening the criteria for diagnosis is the need of the hour

Lnu

Ansari

Mahto

et al. 2021

BMC Cardiovasc Disord

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Background Transcatheter valve replacement (TAVR) is an important therapeutic intervention for patients with aortic valve stenosis. As TAVR has become available to a broader population, there has been an increase in the number of less common, yet potentially catastrophic, complications. TAVR related infective endocarditis (TAVR-IE) is a rare, but potentially fatal, complication. Case series We present here two patients that we encountered for TAVR associated infective endocarditis. Our first patient presented 5 weeks after his TAVR. His initial presentation was consistent with signs of sepsis. The patient then developed Mobitz type I block during hospital course. His TEE was negative for features of infective endocarditis. Due to high suspicion, patient was taken for surgical exploration and was found to have multiple foci of vegetation adhered to the stent frame. Our second patient presented with new onset pulmonary edema, worsening heart failure and systemic inflammatory response. A TEE was done for persistent MSSA bacteremia which showed stable prosthetic valve function with no signs of infective endocarditis. Patient was discharged with a prolonged course of intravenous antibiotics. Patient was re-admitted for worsening sepsis and blood cultures were positive for MSSA. Patient was taken for surgical exploration of his prosthetic aortic valve which showed purulent aortic root abscess. Conclusion Through these cases, we aim to raise awareness on TAVR-IE. Due to the atypical clinical presentation, the modified Duke criteria may not be sufficient to diagnose TAVR-IE. Transesophageal echocardiogram in TAVR-IE may be negative or indeterminate. Prosthetic valve shadow may obscure smaller vegetations and/or smaller abscesses. A negative transesophageal echocardiogram should not rule out TAVR-IE and further diagnostic imaging modalities should be considered. PET/CT after administration of 18F-FDG (fluorodeoxyglucose) is a useful diagnostic tool in the diagnosis of infective endocarditis where TEE has been negative or inconclusive. Multi-modal imaging, in addition to the modified Duke criteria, can facilitate early diagnosis and improved mortality outcomes.

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Pseudomonas aeruginosa Infective Endocarditis Following Transcatheter Aortic Valve Implantation: A Note of Caution

Cited by 8 publications

References 22 publications

Infective endocarditis after TAVI: a meta-analysis and systematic review of epidemiology, risk factors and clinical consequences

Infective endocarditis after TAVI: a meta-analysis and systematic review of epidemiology, risk factors and clinical consequences

Transcatheter Aortic Valve Replacement–Associated Prosthetic Valve Endocarditis Due to Pseudomonas aeruginosa

Transcatheter aortic valve replacement associated infective endocarditis case series: broadening the criteria for diagnosis is the need of the hour

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