Thoracic organ transplantation may not increase the risk of bacterial transmission in intensive care units

Abstract

A transmission study was performed to investigate whether organ recipients suffer more transmissions of bacteria than do non-transplanted patients. We chose enterococci for molecular typing because of their high prevalence, transmissibility, and predominance in causing nosocomial infections. Patients staying longer than 48 h in a cardiovascular surgery intensive care unit (ICU) were included in our one-year prospective cohort study. Enterococci identified from clinical or surveillance isolates were collected and typed by PFGE. Episodes of transmission were defined by the identification of genetically indistinguishable isolates in two or more patients who were treated during overlapping intervals or within a 9-day window period in the same ICU. Risk factor analysis was performed. Out of 585 patients microbiological specimens were cultured from 336 patients. From 187 of these, enterococci were isolated. From 81 patients 186 enterococci isolates were typed. Out of 105 different enterococci strains, 16 cluster strains were detected and 30 episodes of transmissions occurred. The transmission rate was 7.8 per 1000 patient days. No significant association was found between “being cluster member “and “patient organ transplanted” (OR 1.5, CI 95% 0.58; 3.98, p = 0.38 ) or “patient treated in a single-room only” (OR 1.06, CI 95% 0.36;3, 12, p = 0.91 ), respectively. In contrast, “being cluster member” was associated with a prolonged length of stay (OR per additional days of stay 1.05, CI 95% 1.01–1.09, p < 0.01 ). Thoracic organ transplantation was not found to be a risk factor for bacterial transmission, but transmission was associated with a prolonged length of stay.