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Periprocedural antibiotic treatment in transvascular aortic valve replacement

Bruna Gomes1, Nicolas A Geis1, Florian Leuschner1

  • 1Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany.

Journal of Interventional Cardiology
|November 7, 2018
PubMed
Abstract

Insights

A 1-day Cefuroxime antibiotic regimen for transcatheter aortic valve replacement (TAVR) is as effective as a 3-day regimen. The shorter regimen significantly reduces the risk of diarrhea and Clostridium difficile infections.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Surgical Prophylaxis

Background:

  • Current guidelines lack specific antibiotic prophylaxis recommendations for transcatheter aortic valve replacement (TAVR).
  • This study evaluates clinical outcomes associated with different periprocedural antibiotic regimens in TAVR patients.

Purpose of the Study:

  • To compare the efficacy and safety of 1-day versus 3-day Cefuroxime prophylaxis in TAVR procedures.
  • To assess the impact of antibiotic duration on hospitalization, infection rates, and other clinical outcomes.

Main Methods:

  • A total of 450 consecutive TAVR patients were analyzed.
  • Patients were divided into two groups: 1-day Cefuroxime prophylaxis (N=225) and 3-day Cefuroxime prophylaxis (N=225).
  • Data were collected between February 2014 and June 2016, following a change in institutional antibiotic prophylaxis rules in May 2015.

Main Results:

  • Hospitalization duration was similar between the 1-day and 3-day Cefuroxime groups (8.9 ± 4.0 vs. 9 ± 4.7 days, P=0.87).
  • The 3-day Cefuroxime group showed significantly higher incidences of diarrhea (26.2% vs. 18.2%, P=0.04) and Clostridium difficile infections (4% vs. 0.4%, P=0.01).
  • No significant differences were observed in 30-day mortality, major vascular complications, bleeding, pacemaker implantation, paravalvular regurgitation, or acute kidney injury.

Conclusions:

  • A 3-day Cefuroxime prophylaxis regimen offers no apparent advantage over a 1-day regimen in TAVR patients.
  • The shorter 1-day regimen is associated with a lower incidence of gastrointestinal side effects, including diarrhea and C. difficile infections.
Keywords:
TAVRantibiotic prophylaxisaortic stenosisendocarditis

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