Frequency, pattern, and cause of fever following transfemoral transcatheter aortic valve implantation.
Fever after transcatheter aortic valve implantation (TAVI) is common and may result in extensive workup, treatment with broad-spectrum antibiotics, and prolonged hospitalization. Despite these consequences, the prevalence and nature of fever after TAVI and whether cases of fever could be attributed to an infectious origin have not been studied thoroughly to date. We conducted an observational retrospective analysis of 148 consecutive patients undergoing percutaneous transfemoral TAVI at the Tel-Aviv Medical Center. All patients were treated with antibiotic prophylaxis using first- or second-generation cephalosporins (or vancomycin upon a β-lactam allergy) on the procedure day. Medical and nursing records were reviewed for the occurrence, extent, and origin of fever. Laboratory databases were screened for positive cultures. Fever ≥37.5°C occurred in 66 patients (47%) and ≥38.0°C in 27 patients (19.4%). Most febrile episodes ≥38.0°C were of short duration, lasting <8 hours (59.3%, n = 16), and occurred in the first 48 hours after procedure (74%, n = 22). Bacteremia was found in 2 cases and urinary tract infection in 3 other cases; most pathogens isolated were resistant to prophylactic antibiotic regimen. Unlike prolonged fever, a short febrile episode was not associated with an extended hospital stay or with increased 30-day mortality rate after TAVI. In conclusion, fever after TAVI occurs frequently and may represent a noninfectious inflammatory response as it rarely associates with a documented bacterial infection. Therefore, deferring antibiotic therapy in an otherwise well post-TAVI patient with a short febrile episode should be considered, whereas prolonged and high-grade fever warrants further workup and empirical antibiotic therapy.
Department of Cardiology, Tel-Aviv Medical Center, and The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: dr.eranleshem@gmail.com.
Eran
E
Leshem-Rubinow
Infectious Diseases Unit, Tel-Aviv Medical Center, and The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Sharon
S
Amit
Department of Cardiology, Tel-Aviv Medical Center, and The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Arie
A
Steinvil
Department of Cardiology, Tel-Aviv Medical Center, and The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Eyal
E
Ben-Assa
Department of Cardiology, Tel-Aviv Medical Center, and The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Yigal
Y
Abramowitz
Department of Cardiology, Tel-Aviv Medical Center, and The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Gad
G
Keren
Infectious Diseases Unit, Tel-Aviv Medical Center, and The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Ronen
R
Ben-Ami
Department of Cardiology, Tel-Aviv Medical Center, and The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Shmuel
S
Banai
Department of Cardiology, Tel-Aviv Medical Center, and The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Ariel
A
Finkelstein
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D055499:Catheter-Related Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
D000900:Anti-Bacterial Agents