Infectieuze endocarditis na TAVI: diabetes belangrijkste risicofactor, E. faecalis dominante verwekker, 2× mortaliteit

<sec><st>Aims</st> <p>Infective endocarditis following transcatheter aortic valve implantation (TAVI-IE) is an uncommon but clinically devastating complication. We aimed to identify risk factors for TAVI-IE and to estimate its association with all-cause mortality.</p> </sec> <sec><st>Methods and results</st> <p>We conducted a case-control study including patients who underwent TAVI at Haukeland University Hospital, Norway, between 2012 and 2023. Patients who developed TAVI-IE (n=71) were compared with age-matched and sex-matched controls without IE (n=213; 1:3 ratio). Death was treated as a competing event in analyses of IE, and we estimated the subdistribution HRs (SHR) for IE using Fine-Gray competing risk regression. Cox regression models with IE as a time-dependent covariate assessed the impact of infection on mortality.</p> <p>The incidence of TAVI-IE was 1.2% per patient-year with a median time from TAVI to infection of 13 months (IQR 4&ndash;29). In multivariable competing risk analysis, diabetes mellitus remained an independent predictor of TAVI-IE (SHR 2.08, 95% CI 1.19 to 3.65, p=0.010). Obesity (27% vs 15%, p=0.019) and balloon-expandable valve use (28% vs 13%, p=0.003) were more often observed in patients with TAVI-IE. <I>Enterococcus faecalis</I> was the most frequent pathogen (30%). TAVI-IE was associated with an approximately twofold increase in all-cause mortality (adjusted HR 2.13, 95% CI 1.48 to 3.07, p&lt;0.001) with the highest risk in early infections.</p> </sec> <sec><st>Conclusion</st> <p>TAVI-IE is an infrequent but severe complication associated with excess mortality. Diabetes mellitus was the dominant independent risk factor and <I>E. faecalis</I> the leading pathogen. These findings may help target monitoring and prevention in patients at the highest risk.</p> </sec>