Clarunis, University Hospital Basel, Basel, Switzerland.
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland.
J Hosp Infect. 2022 Nov;129:198-202. doi: 10.1016/j.jhin.2022.07.020. Epub 2022 Aug 6.
Cephalosporins are recommended for prophylaxis before transcatheter aortic valve replacement (TAVR). Infective endocarditis (IE) after TAVR is caused by enterococci in up to 30% of cases, particularly early after TAVR. Enterococcal colonization in the groin has been postulated as a source of infection, not only because prophylaxis does not cover enterococci but also because most TAVR procedures are performed by transfemoral access. There are few data analysing the groin microbiome to demonstrate the presence of enterococci.
To assess the prevalence of enterococci in the groins of cardiological patients receiving transfemoral interventions.
This prospective cohort study was undertaken at University Hospital Basel, Switzerland between February and August 2020. Two skin swabs were taken from the groins of consecutive patients undergoing transfemoral cardiac interventions before the administration of antibiotic prophylaxis; for each patient, swabs were taken before and after groin disinfection. Swabs were analysed in the local microbiological laboratory following validated culture methods.
Of 290 included patients, 245 (84.5%) underwent coronary angiography, 31 (10.7%) underwent TAVR, eight (2.8%) underwent right heart catheterization, five (1.7%) underwent closure of patent foramen ovale, and one (0.3%) underwent a MitraClip procedure. Enterococci were detected before disinfection in 48 patients, enterococci were still cultured after disinfection in three patients, and enterococci were detected after disinfection alone (i.e. not detected before disinfection) in one patient. The prevalence of enterococci was 16.6% before disinfection and 1.4% after disinfection. Patients colonized with enterococci had a significantly higher body mass index and were more likely to be diabetic than uncolonized patients.
Common enterococcal colonization of the groin, coupled with frequent isolation of enterococci from patients with TAVR-associated IE, provides strong evidence that the current recommendation of antimicrobial prophylaxis with cephalosporins before TAVR should be changed to antimicrobial prophylaxis with a compound that is active against enterococci.
头孢菌素类药物被推荐用于经导管主动脉瓣置换术（TAVR）前的预防。TAVR 后感染性心内膜炎（IE）的病因有 30%是肠球菌，尤其是在 TAVR 后早期。股部肠球菌定植被认为是感染源，不仅因为预防措施不能覆盖肠球菌，而且因为大多数 TAVR 程序都是经股动脉入路进行的。很少有数据分析股部微生物组以证明肠球菌的存在。
评估接受经股动脉介入治疗的心脏病患者股部肠球菌的流行率。
这是一项在瑞士巴塞尔大学医院进行的前瞻性队列研究，于 2020 年 2 月至 8 月进行。连续接受经股心内介入治疗的患者在给予抗生素预防前，从股部采集两个皮肤拭子；对于每个患者，在股部消毒前后采集拭子。按照经过验证的培养方法，在当地微生物实验室分析拭子。
在 290 例纳入的患者中，245 例（84.5%）接受冠状动脉造影，31 例（10.7%）接受 TAVR，8 例（2.8%）接受右心导管检查，5 例（1.7%）接受卵圆孔未闭封堵术，1 例（0.3%）接受 MitraClip 手术。在消毒前，48 例患者培养出肠球菌，在消毒后，3 例患者仍培养出肠球菌，1 例患者仅在消毒后（即消毒前未检出）检出肠球菌。消毒前肠球菌的流行率为 16.6%，消毒后为 1.4%。定植肠球菌的患者体重指数明显较高，且较未定植患者更有可能患有糖尿病。
股部常见肠球菌定植，再加上 TAVR 相关 IE 患者常分离出肠球菌，有力证明当前 TAVR 前头孢菌素类药物预防的建议应更改为对肠球菌有效的抗菌药物预防。
