Bloodstream infection in heart transplant recipients: 12-year experience at a university hospital in Taiwan

• Published in: European journal of cardio-thoracic surgery 2011-12, Vol.40 (6), p.1362-1367
• Main Authors: Hsu, Ron-Bin, Chang, Chung-I, Fang, Chi-Tai, Chang, Shan-Chwen, Wang, Shoei-Shen, Chu, Shu-Hsun
• Format: Article
• Language: English
• Subjects: Acinetobacter baumannii; Adolescent; Adult; Aged; Antibiotic Prophylaxis - methods; Bacteremia - epidemiology; Bacteremia - etiology; Bacteremia - prevention & control; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Candida; Cardiology. Vascular system; Child; Child, Preschool; Cross Infection - epidemiology; Cross Infection - etiology; Cross Infection - prevention & control; Cryptococcus; Enterobacter; Epidemiologic Methods; Female; Gram-Negative Bacterial Infections - epidemiology; Gram-Negative Bacterial Infections - etiology; Gram-Negative Bacterial Infections - prevention & control; Heart Transplantation - adverse effects; Hospitals, University; Human bacterial diseases; Humans; Immunosuppression - adverse effects; Immunosuppression - methods; Infant; Infectious diseases; Male; Medical sciences; Middle Aged; Opportunistic Infections - epidemiology; Opportunistic Infections - etiology; Opportunistic Infections - prevention & control; Pneumology; Postoperative Period; Pseudomonas; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Taiwan - epidemiology; Young Adult
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2011.02.033

Abstract Objective: Bloodstream infection (BSI) is a well-recognized problem and it affects 10-50% of solid organ transplant recipients. The purpose of this study was to assess the incidence and prognosis of BSI in heart transplant recipients at our hospital. Methods: The study is a retrospective chart review. Results: We diagnosed 101 episodes of BSI in 73 out of 306 heart transplant patients (24%) during the 12-year study period. BSI occurred at a median of 191 days (range 1-3376) after transplant and 50% occurred within 6 months after transplant. Most BSI episodes were nosocomial (73%), especially those occurring within the first month (94%). As far as pathogen was concerned, Gram-negative bacteria predominated (57%), followed by Gram-positive bacteria (34%), fungus (5%), anaerobics (2%), and cryptococcus (2%). Overall 30-day mortality rate was 30%. Death occurred in 36% (13/36) of the patients with early-onset BSI, 14% (2/14) of the patients with BSI in months 2-6, and 29% (15/51) of the patients with late-onset BSI. Mortality rate was over 50% in those patients with Pseudomonal infection, fungal infection, cryptococcal infection of central nervous system, lung infection, and severe sepsis. Compared to Western series, there was a high incidence of infections caused by Enterobacter species and Acinetobacter baumannii. Conclusions: There was a high incidence of BSI after heart transplantation in Taiwan, especially infections caused by Enterobacter species and A. baumannii. Mortality was high in patients with infection caused by Pseudomonas, Candida, and Cryptococcus and in patients with severe sepsis.