What are the guidelines for prophylactic antibiotics in abdominal procedures following Transcatheter Aortic Valve Replacement (TAVR)?

From the Guidelines

Prophylactic antibiotics for abdominal procedures following TAVR should include a single preoperative dose of a cephalosporin, such as cefazolin (1-2g IV), administered within 60 minutes before surgical incision, as recommended by recent guidelines 1.

Key Considerations

• For patients with beta-lactam allergies, alternatives include clindamycin (600-900mg IV) or vancomycin (15mg/kg IV) 1.
• The antibiotic coverage should be extended for 24-48 hours post-procedure only if there are specific risk factors such as immunosuppression, prosthetic material implantation, or contamination during the procedure.
• For abdominal procedures with higher infection risk (such as colorectal surgery), broader coverage may be warranted with addition of metronidazole (500mg IV) or using broader-spectrum agents like piperacillin-tazobactam (3.375g IV) 1.

Special Considerations for TAVR Patients

• Special consideration should be given to TAVR patients due to their prosthetic heart valve, which increases endocarditis risk.
• The timing between TAVR and subsequent abdominal procedures is also important, with higher vigilance recommended within the first six months post-TAVR when endothelialization of the valve is incomplete.

Balancing Risks and Benefits

• These recommendations aim to prevent both surgical site infections and prosthetic valve endocarditis, balancing adequate antimicrobial coverage against risks of antibiotic resistance and adverse effects 1.

Evidence-Based Recommendations

• The choice of antibiotic should be based on local guidelines and should be different from the drug of choice for treatment of established infections 1.
• Skin preparation with a scrub of chlorhexidine-alcohol has been claimed to be superior to povidone-iodine in preventing surgical-site infections, but the difference is likely to be very small 1.

From the Research

Guidelines for Prophylactic Antibiotics in Abdominal Procedures

There are no specific guidelines provided in the given studies for prophylactic antibiotics in abdominal procedures following Transcatheter Aortic Valve Replacement (TAVR). However, the studies provide general information on the use of prophylactic antibiotics in abdominal surgery.

Choice of Antibiotic Agent

• The choice of antibiotic agent should be based on the type of organisms usually causing infection 2
• Cefazolin is recommended for aseptic (clean) operations due to its excellent pharmacokinetics and good activity against gram-positive pathogens, including staphylococci 3
• A cefotaxime-generation cephalosporin is the agent of choice for operations where violation of the digestive tract creates a contaminated field 3

Administration of Prophylactic Antibiotics

• The route of administration must be appropriate 2
• The dosage necessary to attain efficacious levels of antibiotic in tissue or serum must be appropriate 2
• The timing of administration should offer the maximal benefits without risk of the adverse effects 2
• A single prophylactic dose is necessary, given at the time of induction of anesthesia 3
• For particularly long operations, a second dose of those antibiotics with half-lives shorter than 60 min is required two hours after the first 3

Reduction of Postoperative Infections

• The use of probiotics/synbiotics may reduce postoperative infections after abdominal surgery 4
• Appropriate antibiotic selection and timing of administration for prophylaxis are crucial to reduce the likelihood of surgical site infection after elective colorectal surgery 5