Risk Factors and Outcome of Multidrug-Resistant Infections after Heart Transplant: A Contemporary Single Center Experience.

Arta Karruli,Mariano Bernardo,Irene Mattucci,Cristiano Amarelli,Domenico Iossa,Emanuele Durante-Mangoni,Jacopo De Cristofaro,Roberto Andini,Raffaele Zarrilli,Rosa Zampino

doi:10.3390/microorganisms9061210

Abstract

(1) Background: The aim of this study was to assess risk factors for multidrug-resistant/extensively drug-resistant (MDR/XDR) bacterial infections in heart transplant (HT) patients within three months after surgery and its impact on patient outcome. (2) Methods: Retrospective analysis of clinical, hemato-chemical, imaging, treatment and outcome data from 47 heart transplant recipients from January 2016 to December 2018. MDR/XDR infections were compared to non-MDR/XDR and noninfected patients. (3) Results: Most participants were males, median age 51 years: 35 (74.5%) developed an infection after HT; 14 (29.8%) were MDR/XDR infections. Prolonged hospital stay before HT correlated to MDR/XDR infection (p < 0.001). Sequential organ failure assessment (SOFA) score at sampling day was higher in MDR/XDR (p = 0.027). MDR/XDR were mostly blood-stream (BSI) (p = 0.043) and skin-soft tissue (SSTI) (p = 0.047) infections. Gram-negative infections were the most frequent, specifically carbapenem-resistant Klebsiella pneumoniae. Antibiotic therapy duration for MDR/XDR infections was longer (p = 0.057), eradication rate lower (p = 0.083) and hospital stay longer (p = 0.005) but not associated with a worse outcome. (4) Conclusions: MDR/XDR infections affect compromised HT recipients with a history of prolonged hospitalization, causing a lower rate of eradication and increased hospital stay. These frequently present as BSI and SSTI. We emphasize the need to prevent contamination of central venous catheters and the surgical site.

Highlights

IntroductionHeart transplantation is currently considered the treatment of choice for end-stage heart failure, showing the best short- and long-term clinical outcomes [1,2]
Hospital mortality of heart transplant recipients may be as high as 10%, with organ rejection and infections remaining the major causes of an unfavorable outcome [3,6]
Among general clinical data we considered age, sex, body mass index (BMI), comorbidities, length of hospital and intensive care unit (ICU) stay, hospitalization in the 90 days prior to heart transplant, previous automatic implantable cardioverter-defibrillator (AICD) implant, previous placement of mechanical circulatory support devices [intra-aortic balloon pump (IABP), left ventricular assist device (L-VAD), extracorporeal membrane oxygenation (ECMO)]

Summary

Introduction

Heart transplantation is currently considered the treatment of choice for end-stage heart failure, showing the best short- and long-term clinical outcomes [1,2]. Most transplant candidates present compromised health conditions due to primary organ disease as well as various comorbidities [3]. Following transplant, a pharmacologically-induced immune suppressive state ensues and, while under-immune suppression, may result in organ rejection [4]. Over-immune suppression may pose patients at an increased risk of infection, still a major cause of morbidity and mortality after surgery [5]. Hospital mortality of heart transplant recipients may be as high as 10%, with organ rejection and infections remaining the major causes of an unfavorable outcome [3,6]

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