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
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...
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| Main Authors: | , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
26 February 2020
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| In: |
Journal of infection
Year: 2020, Volume: 80, Issue: 5, Pages: 511-518 |
| ISSN: | 1532-2742 |
| DOI: | 10.1016/j.jinf.2020.02.015 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.jinf.2020.02.015 Verlag, lizenzpflichtig, Volltext: https://linkinghub.elsevier.com/retrieve/pii/S0163445320300979 
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| Author Notes: | Dennis Nurjadi, Katharina Last, Sabrina Klein, Sébastien Boutin, Bastian Schmack, Florian Mueller, Klaus Heeg, Arjang Ruhparwar, Alexandra Heininger, Philipp Zanger |
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| 245 | 1 | 0 | |a Nasal colonization with Staphylococcus aureus is a risk factor for ventricular assist device infection in the first year after implantation |b a prospective, single-centre, cohort study |c Dennis Nurjadi, Katharina Last, Sabrina Klein, Sébastien Boutin, Bastian Schmack, Florian Mueller, Klaus Heeg, Arjang Ruhparwar, Alexandra Heininger, Philipp Zanger |
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| 520 | |a 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. | ||
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