The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

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

DOI: 10.4244/EIJ-D-19-00993

1. Department of Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Switzerland, Switzerland
2. Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Switzerland
3. Department of Fundamental Microbiology, University of Lausanne, Switzerland
4. Department of Clinical Microbiology, Mater Misericordiae University Hospital, University College Dublin, Ireland
5. Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Switzerland
6. Department of Cardiology, University Hospital Basel, University of Basel, Switzerland

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Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is a new disease entity. The rate of IE after TAVI is like that after surgical aortic valve replacement, 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 Organisation as well as guidelines by professional societies from Europe and the United States. Such interim recommendations based on expert opinions are likely justified until large randomized trials provide the strong evidence for infection control in TAVI, because IE after TAVI is often related to the TAVI procedure itself and the 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 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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