BACTERAEMIA and infective endocarditis (IE) are significantly more common within six months after transcatheter aortic valve implantation (TAVI) compared with elective coronary angiography (CAG), recent research has shown, highlighting a need to reassess prophylactic antibiotic strategies.
This nationwide cohort study utilised Danish registries to evaluate the incidence, microbiological profile, and mortality associated with bacteraemia and IE following TAVI. Researchers included all patients undergoing TAVI from 2012 to 2021, matching them 1:1 with patients undergoing elective CAG by age, sex, and year of the procedure. The primary outcomes were the cumulative six-month incidence of bacteraemia and IE, assessed using statistical models to adjust for baseline differences.
The study examined 5990 first-time TAVI patients (57% male, mean age 80 years) and their matched CAG counterparts. Bacteraemia was observed in 4.2% of TAVI patients within six months, compared to 2.6% in the CAG group, with an adjusted hazard ratio (HR) of 1.57 (95% CI 1.26 to 1.96). Pathogen profiles differed between groups: TAVI patients showed higher rates of Streptococci (20%), Coagulase-negative staphylococci (19%), and Enterococci (18%), whereas CAG patients had higher rates of Coagulase-negative staphylococci (22%) and Staphylococcus aureus (16%). IE occurred in 1.1% of TAVI patients, a stark contrast to 0.1% in the CAG group, corresponding to an adjusted HR of 20.01 (95% CI 5.97 to 67.48).
The findings suggest that TAVI patients are at a markedly elevated risk of post-procedure bacteraemia and IE, potentially due to procedural factors and pre-existing vulnerabilities. Current prophylactic antibiotic regimens appear inadequate in addressing the microbiological threats specific to TAVI. Clinicians should consider tailoring antibiotic strategies and implementing rigorous monitoring protocols for early detection and treatment of infections in this high-risk population. Future research should explore personalised prophylaxis and procedural modifications to mitigate infection risks, aiming to improve post-TAVI outcomes.
Katrina Thornber, EMJ
Reference
Hadji-Turdeghal K et al. Bacteraemia after transcatheter aortic valve implantation: a nationwide cohort study. Heart. 2024;DOI:10.1136/heartjnl-2024-324803.
