Bloodstream infection reduction rate within the first month after heart and lung transplant with broader spectrum antimicrobial prophylaxis

Abstract

Introduction: Bloodstream infections (BSIs) occur early in the post transplant period, the aim of this retrospective study was to evaluate whether a broather antimicrobial prophylaxis at transplant could be helpful in reducing BSI incidence. Method:All BSI episodes occurring considered as early (until 30 days after transplant) or late events (from 31days to 365 days after transplant) were recorded. Before October 1st, 2018, vancomycin was used as prophylaxis at transplant (period 1); after October 1st,2018 prophylaxis included vancomycin and piperacillin/tazobactam (period 2) or a targeted prophylaxis according to the colonization bacteria detected through rectal swab.Results: One-hundred-fifteen patients received a SOT during the study (77 in period 1 and 38 in period 2),73 (63.5%) heart recipients, and 42 (36.5%) lung recipients. Fifty-four BSI episodes were recorded in 41 patients (36.7%). Gram-negative bacteria were responsible for the majority of BSIs. Twenty-four patients died during the study timeframe (22%) (type of SOT: 18 heart, 6 lung transplanted patients), having a BSI was a risk factor for death (HR 5.2; 95% CI 2.1-12-5, p<0.001).BSIs in the first 30 days after transplant accounted for 48% of all events. Overall BSI incidence rate was 1.15 per 100 patient/days in the first 30 days after transplant; 1.49 per 100 patient/days in period 1 and 0.58 per 100 patient/days in period 2. The use of broader antimicrobial prophylaxis was associated with reduced BSI in period 2 compared to period 1 (HR 0.39; 95%CI 0.16-0.93, p=0.035); CKD was associated with increased BSI risk (HR 2.45; 95% CI 1.1-6, p=0.048). At multivariate analysis the risk of BSI still remained reduced in period 2 (HR 0.38; 95%CI 0.14-1, p=0.05). BSI incidence between 31 and 365 days after transplant was 0.15 per 100 patient/days, age remained associated to BSI in the late period at multivariate analysis. Discussion: Broader antimicrobial prophylaxis at transplant is an option to reduce BSI incidence in the first month after transplant.