Nasal colonization with Staphylococcus aureus is a risk factor for ventricular assist device infection in the first year after implantation

• Verfasst von: Nurjadi, Dennis [VerfasserIn]
• Verfasst von: Last, Katharina [VerfasserIn]
• Verfasst von: Klein, Sabrina [VerfasserIn]
• Verfasst von: Boutin, Sébastien [VerfasserIn]
• Verfasst von: Schmack, Bastian [VerfasserIn]
• Verfasst von: Müller, Florian [VerfasserIn]
• Verfasst von: Heeg, Klaus [VerfasserIn]
• Verfasst von: Ruhparwar, Arjang [VerfasserIn]
• Verfasst von: Heininger, Alexandra [VerfasserIn]
• Verfasst von: Zanger, Philipp [VerfasserIn]
• Titel: Nasal colonization with Staphylococcus aureus is a risk factor for ventricular assist device infection in the first year after implantation
• Titelzusatz: a prospective, single-centre, cohort study
• Verf.angabe: Dennis Nurjadi, Katharina Last, Sabrina Klein, Sébastien Boutin, Bastian Schmack, Florian Mueller, Klaus Heeg, Arjang Ruhparwar, Alexandra Heininger, Philipp Zanger
• E-Jahr: 2020
• Jahr: 26 February 2020
• Umfang: 8 S.
• Fussnoten: Gesehen am 12.05.2020
• Titel Quelle: Enthalten in: Journal of infection
• Ort Quelle: Amsterdam [u.a.] : Elsevier, 1979
• Jahr Quelle: 2020
• Band/Heft Quelle: 80(2020), 5, Seite 511-518
• ISSN Quelle: 1532-2742
• DOI: doi:10.1016/j.jinf.2020.02.015
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1698039719

Abstract

Objectives: To assess, whether S. aureus nasal colonization is a risk factor for infections in patients with durable ventricular assist device (VAD). - Methods: 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. - Results: 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. - Conclusions: 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.