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

Melana Yuzefpolskaya; Heidi S. Lumish; Azka Javaid; Barbara Cagliostro; Giulio M. Mondellini; Bruno Bohn; Austin Sweat; Duygu Onat; Lorenzo Braghieri; Koji Takeda; Yoshifumi Naka; Gabriel T. Sayer; Nir Uriel; Justin G. Aaron; Emmanuel Montassier; Ryan T. Demmer; Paolo C. Colombo

doi:10.1002/ejhf.2215

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

Melana Yuzefpolskaya, Heidi S. Lumish, Azka Javaid, Barbara Cagliostro, Giulio M. Mondellini, Bruno Bohn, Austin Sweat, Duygu Onat, Lorenzo Braghieri, Koji Takeda, Yoshifumi Naka, Gabriel T. Sayer, Nir Uriel, Justin G. Aaron, Emmanuel Montassier, Ryan T. Demmer, Paolo C. Colombo

Epidemiology & Community Health

Research output: Contribution to journal › Article › peer-review

9 Scopus citations

Abstract

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 < 0.05).

CONCLUSIONS: Pre-LVAD infections are common. BSIs independently predict postoperative mortality and infections. Additional studies are needed to confirm our findings that pre-LVAD SA nasal colonization and gut microbial composition can help stratify patients' risk for infectious complications after LVAD implantation.

Original language	English (US)
Pages (from-to)	1404-1415
Number of pages	12
Journal	European Journal of Heart Failure
Volume	23
Issue number	8
DOIs	https://doi.org/10.1002/ejhf.2215
State	Published - Aug 2021

Bibliographical note

Funding Information:
: Y.N. serves as a consultant for Abbott. N.U. serves on advisory boards for Leviticus and Livemetric/Cormetric. P.C.C. is recipient of a research grant from Abbott; he also serves as a consultant (with no honoraria) for the same company. All other authors have nothing to disclose. Conflict of interest

Funding Information:
This research has been supported by funds from the Susan and Lowell McAdam Heart Failure Research Initiative and the Lisa and Mark Schwartz Program to Reverse Heart Failure at New York‐Presbyterian Hospital/Columbia University.

Publisher Copyright:
© 2021 European Society of Cardiology.

Keywords

Heart failure
Infection
Inflammation
Left ventricular assist device
Microbiome

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1002/ejhf.2215

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Yuzefpolskaya, M., Lumish, H. S., Javaid, A., Cagliostro, B., Mondellini, G. M., Bohn, B., Sweat, A., Onat, D., Braghieri, L., Takeda, K., Naka, Y., Sayer, G. T., Uriel, N., Aaron, J. G., Montassier, E., Demmer, R. T., & Colombo, P. C. (2021). Association of preoperative infections, nasal Staphylococcus aureus colonization and gut microbiota with left ventricular assist device outcomes. European Journal of Heart Failure, 23(8), 1404-1415. https://doi.org/10.1002/ejhf.2215

Yuzefpolskaya, M, Lumish, HS, Javaid, A, Cagliostro, B, Mondellini, GM, Bohn, B, Sweat, A, Onat, D, Braghieri, L, Takeda, K, Naka, Y, Sayer, GT, Uriel, N, Aaron, JG, Montassier, E, Demmer, RT & Colombo, PC 2021, 'Association of preoperative infections, nasal Staphylococcus aureus colonization and gut microbiota with left ventricular assist device outcomes', European Journal of Heart Failure, vol. 23, no. 8, pp. 1404-1415. https://doi.org/10.1002/ejhf.2215

@article{9c06b643f4944dfbb2fb7117506d037d,

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

abstract = "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 < 0.05).CONCLUSIONS: Pre-LVAD infections are common. BSIs independently predict postoperative mortality and infections. Additional studies are needed to confirm our findings that pre-LVAD SA nasal colonization and gut microbial composition can help stratify patients' risk for infectious complications after LVAD implantation.",

keywords = "Heart failure, Infection, Inflammation, Left ventricular assist device, Microbiome",

author = "Melana Yuzefpolskaya and Lumish, {Heidi S.} and Azka Javaid and Barbara Cagliostro and Mondellini, {Giulio M.} and Bruno Bohn and Austin Sweat and Duygu Onat and Lorenzo Braghieri and Koji Takeda and Yoshifumi Naka and Sayer, {Gabriel T.} and Nir Uriel and Aaron, {Justin G.} and Emmanuel Montassier and Demmer, {Ryan T.} and Colombo, {Paolo C.}",

note = "Funding Information: : Y.N. serves as a consultant for Abbott. N.U. serves on advisory boards for Leviticus and Livemetric/Cormetric. P.C.C. is recipient of a research grant from Abbott; he also serves as a consultant (with no honoraria) for the same company. All other authors have nothing to disclose. Conflict of interest Funding Information: This research has been supported by funds from the Susan and Lowell McAdam Heart Failure Research Initiative and the Lisa and Mark Schwartz Program to Reverse Heart Failure at New York‐Presbyterian Hospital/Columbia University. Publisher Copyright: {\textcopyright} 2021 European Society of Cardiology.",

year = "2021",

month = aug,

doi = "10.1002/ejhf.2215",

language = "English (US)",

volume = "23",

pages = "1404--1415",

journal = "European Journal of Heart Failure",

issn = "1388-9842",

publisher = "John Wiley and Sons Ltd",

number = "8",

}

TY - JOUR

T1 - Association of preoperative infections, nasal Staphylococcus aureus colonization and gut microbiota with left ventricular assist device outcomes

AU - Yuzefpolskaya, Melana

AU - Lumish, Heidi S.

AU - Javaid, Azka

AU - Cagliostro, Barbara

AU - Mondellini, Giulio M.

AU - Bohn, Bruno

AU - Sweat, Austin

AU - Onat, Duygu

AU - Braghieri, Lorenzo

AU - Takeda, Koji

AU - Naka, Yoshifumi

AU - Sayer, Gabriel T.

AU - Uriel, Nir

AU - Aaron, Justin G.

AU - Montassier, Emmanuel

AU - Demmer, Ryan T.

AU - Colombo, Paolo C.

N1 - Funding Information: : Y.N. serves as a consultant for Abbott. N.U. serves on advisory boards for Leviticus and Livemetric/Cormetric. P.C.C. is recipient of a research grant from Abbott; he also serves as a consultant (with no honoraria) for the same company. All other authors have nothing to disclose. Conflict of interest Funding Information: This research has been supported by funds from the Susan and Lowell McAdam Heart Failure Research Initiative and the Lisa and Mark Schwartz Program to Reverse Heart Failure at New York‐Presbyterian Hospital/Columbia University. Publisher Copyright: © 2021 European Society of Cardiology.

PY - 2021/8

Y1 - 2021/8

N2 - 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 < 0.05).CONCLUSIONS: Pre-LVAD infections are common. BSIs independently predict postoperative mortality and infections. Additional studies are needed to confirm our findings that pre-LVAD SA nasal colonization and gut microbial composition can help stratify patients' risk for infectious complications after LVAD implantation.

AB - 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 < 0.05).CONCLUSIONS: Pre-LVAD infections are common. BSIs independently predict postoperative mortality and infections. Additional studies are needed to confirm our findings that pre-LVAD SA nasal colonization and gut microbial composition can help stratify patients' risk for infectious complications after LVAD implantation.

KW - Heart failure

KW - Infection

KW - Inflammation

KW - Left ventricular assist device

KW - Microbiome

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U2 - 10.1002/ejhf.2215

DO - 10.1002/ejhf.2215

M3 - Article

C2 - 33964186

AN - SCOPUS:85106970589

SN - 1388-9842

VL - 23

SP - 1404

EP - 1415

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

IS - 8

ER -

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

Abstract

Bibliographical note

Keywords

UN SDGs

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