Why the study?
Elevations in inflammatory markers following TAVR frequently trigger preemptive antibiotic therapy, making the distinction between physiological inflammation and true infection essential for rational antibiotic use.
Can the RIAT score, using post-procedure inflammatory markers, accurately predict true infection and guide rational antibiotic use in patients undergoing TAVR?
Cohort (n=1,275)
No
Can the RIAT score, using post-procedure inflammatory markers, accurately predict true infection and guide rational antibiotic use in patients undergoing TAVR?
Odds Ratio: 5.72 (95% CI 2.59–12.64)
p-value: p=<0.001
The RIAT score, incorporating post-TAVR trends in body temperature, WBC, and CRP, can help distinguish true infection from physiological inflammation, potentially reducing the observed overuse of preemptive antibiotics.
Caution advised against equating post-TAVR CRP with infection to curb antibiotic overuse; leaves open RIAT score validation in prospective studies.
Purpose Elevations in inflammatory markers after transcatheter aortic valve replacement (TAVR) often lead to preemptive antibiotic therapy (ABT). Distinguishing between physiological inflammatory reaction and true infection is crucial for rational ABT use. Methods This retrospective study included 1275 consecutive TAVR patients from January 2020 to July 2022. Infectious foci, ABT administration, and inflammatory markers over seven days post-procedure were evaluated. Using multivariable logistic regression, predictors for infection were identified and integrated into the Risk of Infection After TAVR (RIAT) score. Results An infectious focus was retrospectively identified in 2.6% of patients, while 11.4% received ABT. Distinct trends in body temperature (BT), white blood cells (WBC), and C-reactive protein (CRP) were noted, with BT and WBC peaking on day 1 and CRP on day 3. Significant predictors of infection included a rise in BT of ≥ 0.2 °C between day 1 and 3 (odds ratio [OR] 3.08, 95% confidence interval [CI] 1.38–6.88, p = 0.006), elevated WBC counts ≥ 12 × 109/L (OR 3.77, 95% CI 1.67–8.48, p = 0.001), and CRP levels ≥ 80 mg/L (OR 5.72, 95% CI 2.59–12.64, p < 0.001) within three days after TAVR. Integrating these into the RIAT score revealed an infection probability of 1.5% for scores 0–3 points, 9.2% for scores 4–6 points, and 54.5% for scores 7–8 points. Conclusion Our findings indicate significant ABT overuse among TAVR recipients, likely due to misinterpretation of postoperative physiological reactions. Incorporating specific changes and thresholds of BT, WBC, and CRP post-TAVR into the RIAT score improved risk prediction for infection, underscoring its utility in enhancing antibiotic stewardship in this growing patient population.
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Guthoff et al. (2025) conducted a cohort in Severe native aortic stenosis (n=1,275). Elevated CRP levels ≥ 80 mg/L within 3 days post-TAVR vs. CRP < 80 mg/L was evaluated on Confirmed infectious focus within 7 days post-TAVR (OR 5.72, 95% CI 2.59-12.64, p=<0.001).
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