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

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http://hdl.handle.net/2183/31175
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  • Investigación (FCS) [1293]
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Title
In-Hospital Post-Operative Infection after Heart Transplantation: Epidemiology, Clinical Management, and Outcome
Author(s)
Gómez-López, Rocío
Barge-Caballero, Eduardo
Fernández-Ugidos, Paula
Paniagua-Martín, María J.
Barge-Caballero, Gonzalo
Couto-Mallón, David
Solla-Buceta, Miguel
Velasco-García de Sierra, Carlos
Aller-Fernández, Vanesa
Fernández-Arias, Laura
Vázquez-Rodríguez, José Manuel
Crespo-Leiro, María Generosa
Date
2020-02-13
Citation
Gómez-López R, Barge-Caballero E, Fernández-Ugidos P, Paniagua-Martin MJ, Barge-Caballero G, Couto-Mallón D, Solla-Buceta M, Velasco-García de Sierra C, Aller-Fernández V, Fernández-Arias L, Vázquez-Rodríguez JM, Crespo-Leiro MG. In-Hospital Post-Operative Infection after Heart Transplantation: Epidemiology, Clinical Management, and Outcome. Surg Infect (Larchmt). 2020 Mar;21(2):179-191. doi: 10.1089/sur.2019.073. PMID: 31584336.
Abstract
[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%). Ninety-five 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.
Keywords
Heart transplant
Nosocomial infection
Post-operative infection
Sepsis
 
Description
Observational study
Editor version
https://doi.org/10.1089/sur.2019.073
Rights
This is the accepted version of the article which has now been formally published in final form at Surgical Infections. This original submission version of the article may be used for non-commercial purposes in accordance with the Mary Ann Liebert, Inc., publishers’ self-archiving terms and conditions
ISSN
1096-2964

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