Guthoff Henning, Lohner Valerie, Mons Ute, Götz Julia, Wienemann Hendrik, Wrobel Jan, Nienaber Stephan, Macherey-Meyer Sascha, von Stein Philipp, Baldus Stephan, Adam Matti, Körber Maria Isabel, Jung Norma, Mauri Victor
Heart Center, Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
Cardiovascular Epidemiology of Aging, Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Infection. 2025 Feb 7. doi: 10.1007/s15010-025-02485-0.
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.
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.
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 × 10/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.
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.
经导管主动脉瓣置换术（TAVR）后炎症标志物升高常导致预防性抗生素治疗（ABT）。区分生理性炎症反应和真正的感染对于合理使用ABT至关重要。
这项回顾性研究纳入了2020年1月至2022年7月连续的1275例TAVR患者。评估了感染灶、ABT给药情况以及术后7天内的炎症标志物。使用多变量逻辑回归分析确定感染的预测因素，并将其纳入TAVR后感染风险（RIAT）评分。
回顾性分析发现2.6%的患者存在感染灶，11.4%的患者接受了ABT。观察到体温（BT）、白细胞（WBC）和C反应蛋白（CRP）有明显变化趋势，BT和WBC在第1天达到峰值，CRP在第3天达到峰值。感染的显著预测因素包括第1天至第3天BT升高≥0.2°C（比值比[OR]3.08，95%置信区间[CI]1.38 - 6.88，p = 0.006）、WBC计数≥12×10⁹/L（OR 3.77，95%CI 1.67 - 8.48，p = 0.001）以及TAVR后三天内CRP水平≥80mg/L（OR 5.72，95%CI 2.59 - 12.64，p < 0.001）。将这些因素纳入RIAT评分后发现，0 - 3分的患者感染概率为1.5%，4 - 6分的患者为9.2%，7 - 8分的患者为54.5%。
我们的研究结果表明TAVR患者中存在明显的ABT过度使用情况，这可能是由于对术后生理反应的误解所致。将TAVR后BT、WBC和CRP的特定变化及阈值纳入RIAT评分可改善感染风险预测，强调了其在这一不断增长的患者群体中加强抗生素管理的作用。
