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

Research output: Contribution to journalArticlepeer-review

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 languageEnglish (US)
Pages (from-to)1404-1415
Number of pages12
JournalEuropean Journal of Heart Failure
Volume23
Issue number8
DOIs
StatePublished - 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

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't

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