Shultes Kendall C, Shuster Jerrica E, Micek Scott, Vader Justin M, Balsara Keki, Itoh Akinobu, Tellor Bethany R
1 Belmont University College of Pharmacy , Nashville, Tennessee.
2 Department of Pharmacy, Barnes-Jewish Hospital , St. Louis, Missouri.
Surg Infect (Larchmt). 2018 Jul;19(5):516-522. doi: 10.1089/sur.2017.295. Epub 2018 May 18.
Limited data exist on the incidence and outcome of early infection after orthotopic heart transplantation (OHT). The purpose of this study was to describe characteristics and outcomes of OHT recipients with an early infection and to identify predictors of such infections.
This retrospective, single-center study included patients greater than 18 years of age who underwent OHT from February 2009 to May 2014 and had an infection within 30 days of transplantation. Patient demographics, clinical variables, and outcomes were collected. Multivariable logistic regression was performed to identify independent predictors of infection.
Of the 172 eligible OHT recipients, 51 (29.7%) had an early infection. The median time to diagnosis was five days, with gram-negative organisms being slightly more common (58.2%). No differences in mortality rate, rejection, or re-admission were found between the groups. Longer durations of mechanical ventilation and lengths of stay were found in the infection group (p < 0.001). Patients with an early infection also had a higher incidence of mechanical circulatory support, history of drive-line infection, longer duration of mechanical ventilation, continuous renal replacement therapy (CRRT), and delayed chest closure (p < 0.05 for all). Pre-OHT left-ventricular assist device (adjusted odds ratio [AOR] 2.53; 95% confidence interval [CI] 1.015-6.286; p < 0.046), pre-OHT extracorporeal membrane oxygenation (AOR 14.10; 95% CI 1.38-150.5; p = 0.026) and post-OHT CRRT (AOR 3.98; 95% CI 1.67-9.52; p = 0.002) were found to be independent risk factors for an early infection. A total of 90% of the available susceptibility panels for the gram-negative isolates (26/29) were resistant to the standard peri-operative cephalosporin given.
Prior mechanical circulatory support and the acute need for CRRT may predispose OHT patients to an infection early in the post-operative period. Evaluation of peri-operative antimicrobial prophylaxis, based on an individual center's resistance panels, may be warranted.
关于原位心脏移植（OHT）后早期感染的发生率和结局的数据有限。本研究的目的是描述发生早期感染的OHT受者的特征和结局，并确定此类感染的预测因素。
这项回顾性单中心研究纳入了2009年2月至2014年5月接受OHT且年龄大于18岁且在移植后30天内发生感染的患者。收集患者的人口统计学资料、临床变量和结局。进行多变量逻辑回归以确定感染的独立预测因素。
在172例符合条件的OHT受者中，51例（29.7%）发生了早期感染。诊断的中位时间为5天，革兰氏阴性菌略为常见（58.2%）。两组之间在死亡率、排斥反应或再次入院方面未发现差异。感染组的机械通气时间和住院时间更长（p<0.001）。发生早期感染的患者机械循环支持的发生率也更高、有导线感染史、机械通气时间更长、接受持续肾脏替代治疗（CRRT）以及延迟关胸（所有p<0.05）。移植前左心室辅助装置（调整后的优势比[AOR]2.53；95%置信区间[CI]1.015-6.286；p<0.046）、移植前体外膜肺氧合（AOR 14.10；95%CI 1.38-150.5；p=0.026）和移植后CRRT（AOR 3.98；95%CI 1.67-9.52；p=0.002）被发现是早期感染的独立危险因素。革兰氏阴性菌分离株的可用药敏试验结果中，共有90%（26/29）对围手术期给予的标准头孢菌素耐药。
既往的机械循环支持和对CRRT的迫切需求可能使OHT患者在术后早期易发生感染。基于个体中心的耐药谱评估围手术期抗菌药物预防措施可能是必要的。
