Association of preoperative infections, nasal Staphylococcus aureus colonization and gut microbiota with left ventricular assist device outcomes

Aims Infections are common following left ventricular assist device (LVAD) implantation and predict adverse events. Infections are frequent prior to LVAD implantation although their impact on postoperative outcomes remains unknown. Gut and nasal microbial imbalance may predispose to mucosal coloniza...

Full description

Saved in:
Bibliographic Details
Published in:European journal of heart failure 2021-08, Vol.23 (8), p.1404-1415
Main Authors: Yuzefpolskaya, Melana, Lumish, Heidi S., Javaid, Azka, Cagliostro, Barbara, Mondellini, Giulio M., Bohn, Bruno, Sweat, Austin, Onat, Duygu, Braghieri, Lorenzo, Takeda, Koji, Naka, Yoshifumi, Sayer, Gabriel T., Uriel, Nir, Aaron, Justin G., Montassier, Emmanuel, Demmer, Ryan T., Colombo, Paolo C.
Format: Article
Language:English
Subjects:
Gastrointestinal Microbiome
Heart Failure
Heart-Assist Devices
Humans
Infection
Inflammation
Left ventricular assist device
Microbiome
Retrospective Studies
RNA, Ribosomal, 16S
Staphylococcus aureus
Treatment Outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Aims Infections are common following left ventricular assist device (LVAD) implantation and predict adverse events. Infections are frequent prior to LVAD implantation although their impact on postoperative outcomes remains unknown. Gut and nasal microbial imbalance may predispose to mucosal colonization with pathogens. Herein, we investigated the predictive role of pre‐LVAD infections, and explored the association of nasal Staphylococcus aureus (SA) colonization and gut microbiota, on postoperative outcomes. Methods and results Overall, 254 LVAD patients were retrospectively categorized based on pre‐LVAD infection status: Group 1, bacterial/fungal bloodstream infection (BSI); Group 2, other bacterial/fungal; Group 3, viral; and Group 4, no infection. In a subset of patients, nasal SA colonization (n = 140) and pre‐LVAD stool (n = 25) were analysed using 16S rRNA sequencing. A total of 75 (29%) patients had a pre‐LVAD infection [Group 1: 22 (29%); Group 2: 41 (55%); Group 3: 12 (16%)]. Pre‐LVAD BSIs were independent predictors of 1‐year postoperative mortality and infections [Group 1 vs. 4: hazard ratio (HR) 2.70, P = 0.036 vs. HR 1.8, P = 0.046]. In an unadjusted analysis, pre‐LVAD infections other than BSIs, INTERMACS profile ≤2, higher serum creatinine, lower serum albumin and nasal SA colonization were also significantly associated with postoperative infections. Patients with early post‐LVAD infections exhibited decreased microbial diversity (P 
ISSN:1388-9842
1879-0844
DOI:10.1002/ejhf.2215