What is the clinical evidence from this study?

Study design: Review. Population: Infective endocarditis after transcatheter aortic valve implantation. Intervention: Amoxicillin/clavulanic acid vs. Cephalosporin.

February 1, 2021Open Access

A review of recommendations for infective endocarditis prevention in patients undergoing transcatheter aortic valve implantation

Key Result

Antibiotic prophylaxis prior to TAVI should be adapted from an intravenous cephalosporin to an agent covering enterococci, such as amoxicillin/clavulanic acid, to prevent infective endocarditis.

Structured PICO

Do infection prevention measures prevent infective endocarditis in patients undergoing transcatheter aortic valve implantation?

Population

Patients undergoing transcatheter aortic valve implantation (TAVI)

Intervention

Infection prevention measures including antibiotic prophylaxis covering enterococci (e.g., amoxicillin/clavulanic acid) and operating room standards

Outcome

Prevention of infective endocarditis

Due to the high mortality and prevalence of Enterococcus spp. in post-TAVI infective endocarditis, interim guidelines recommend adapting antibiotic prophylaxis to cover enterococci and adhering to operating room standards.

Limitations

Lack of large randomised controlled clinical trials
Observational studies may face serious bias since clinical practices vary widely between hospitals and countries
Evidence for operating room standard recommendations is very low

Abstract

Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is a new disease entity. The rate of IE after TAVI is similar to that after surgical aortic valve replacement (SAVR), but mortality and prevalence of Enterococcus spp. as causing pathogens are significantly higher. Guidelines on infection prevention measures before TAVI procedures are currently lacking. We performed a structured review of the available data to provide interim recommendations based on guidelines to prevent infections issued by the World Health Organization as well as guidelines by professional societies from Europe and the USA. Such interim recommendations based on expert opinions are probably justified until large randomised trials provide strong evidence for infection control in TAVI, because IE after TAVI is often related to the TAVI procedure itself and the associated mortality rate is high. Antibiotic prophylaxis should be adapted from an intravenous cephalosporin to, e.g., amoxicillin/clavulanic acid, to cover enterococci. In addition, infection control should follow operating room standards as far as is reasonable, even if the evidence for this recommendation is very low. These recommendations are endorsed by the International Society for Cardiovascular Infectious Diseases (ISCVID).

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