In-Hospital Post-Operative Infection after Heart Transplantation: Epidemiology, Clinical Management, and Outcome

Abstract

Background: Infection is a major cause of morbidity and mortality after heart transplantation (HT). Little information about its importance in the immediate post-operative period is available.The aim of this study was to analyze the characteristics, incidence, and outcomes of in-hospital post-operative infections after HT. Methods: We conducted an observational, single-center study based on 677 adults who underwent HT from 1991 to 2015 and who survived the surgical intervention. In-hospital post-operative infections were identified retrospectively according to the medical finding in the clinical records.Results: Over a mean hospital stay of 24.5 days, 239 patients (35.3%) developed 348 episodes of infection (2 episodes per 100 patient-days). The most common sources of infection were those related to invasive procedures (respiratory infections, 115 [33%]; urinary tract infections, 47 [13.5%]; bacteremia, 42 [12.1%]; surgical site infections, 25 [7.2%]), in addition to abdominal focus (33, 9.5%). Enterobacteriaceae (76, 21.8%) and gram-positive cocci (58, 16.7%) were the predominant germs, although opportunistic infections were not infrequent (69, 19.8%). Ninetyfive septic episodes were detected with a mean Sequential Organ Failure Assessment Score of 9.5 -5.3 points, with hemodynamic failure being the most severe organ dysfunction and renal dysfunction the most frequent one. Management included broad-spectrum antibiotics in 48.8% of episodes and surgical management in 13.8%. The overall antimicrobial success rate was 96.3%.Higher in-hospital mortality was observed among infected patients (15.1% vs. 10.3%), but this difference was not statistically significant (p = 0.067). The one-year survival and events were not different between patients suffering from a post-operative infection and those who did not. Conclusions:In-hospital infections were frequent in the post-operative period after HT and were associated with a poor short-term outcome. Patients who survived sepsis had a similar one-year morbidity and mortality compared with patients who did not develop an infection.

Impact of pre‐transplant bloodstream infection on clinical outcomes after heart transplantation

“…However, patients who survive sepsis have comparable 1-year morbidity and mortality rates compared to patients who do not develop an infection. 24 In our study, early BSI after HT was an independent risk factor for both in-hospital and 1-year mortality. Patients with pre-transplant BSI had a higher but statistically insignificant incidence of early BSI after HT compared with patients without pre-transplant BSI.…”

“…Nosocomial infections are associated with a poor outcome. However, patients who survive sepsis have comparable 1‐year morbidity and mortality rates compared to patients who do not develop an infection 24 . In our study, early BSI after HT was an independent risk factor for both in‐hospital and 1‐year mortality.…”

“…BSIs are commonly encountered after solid organ transplantation and affect 10%–50% of the recipients 9,24–26 . Nosocomial infections are associated with a poor outcome.…”

“…BSIs are commonly encountered after solid organ transplantation and affect 10%-50% of the recipients. 9,[24][25][26] Nosocomial infections are associated with a poor outcome. However, patients who survive sepsis have comparable 1-year morbidity and mortality rates compared to patients who do not develop an infection.…”

Distribution and resistance of pathogens in infected patients within 1 year after heart transplantation

“…The survival rate after HT is very high, with a median survival of more than 10 years, particularly if it is compared with the natural course of end-stage heart failure (Toyoda et al, 2013). Infection is a major cause of morbidity and mortality after HT (Gómez-López et al, 2020). According to previous research, the incidence of infections following HT varies from 30% to 80%, depending on the definition of infections and the chosen interval time after HT (Grossi et al, 1992;Mattner et al, 2007;Montoya et al, 2001;van de Beek et al, 2008), leading to a death rate of 12%-17% in the first month and 29%-36% in the first year (González-Vílchez et al, 2016;Lund et al, 2013).…”