Department of Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Aarau, Switzerland.
EuroIntervention. 2021 Feb 19;16(14):1135-1140. doi: 10.4244/EIJ-D-19-00993.
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).
经导管主动脉瓣植入术（TAVI）后感染性心内膜炎（IE）是一种新的疾病实体。TAVI 后 IE 的发生率与外科主动脉瓣置换术（SAVR）相似，但死亡率和肠球菌属作为致病病原体的患病率明显更高。目前缺乏 TAVI 术前感染预防措施指南。我们对现有数据进行了系统回顾，根据世界卫生组织以及欧洲和美国专业协会发布的预防感染指南，提供了临时建议。在 TAVI 中提供强有力的感染控制证据的大型随机试验之前，基于专家意见的此类临时建议可能是合理的，因为 TAVI 后 IE 通常与 TAVI 手术本身有关，且相关死亡率较高。抗生素预防应从静脉头孢菌素改为例如阿莫西林/克拉维酸，以覆盖肠球菌。此外，即使该建议的证据非常低，感染控制也应尽可能遵循手术室标准。这些建议得到了国际心血管感染性疾病学会（ISCVID）的认可。
