Pons Stéphanie, Sonneville Romain, Bouadma Lila, Styfalova Lenka, Ruckly Stéphane, Neuville Mathilde, Radjou Aguila, Lebut Jordane, Dilly Marie-Pierre, Mourvillier Bruno, Dorent Richard, Nataf Patrick, Wolff Michel, Timsit Jean-François
Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France.
UMR 1148, LVTS, Sorbonne Paris Cité, Inserm/Paris Diderot University, Paris, France.
Ann Intensive Care. 2019 Jan 25;9(1):17. doi: 10.1186/s13613-019-0490-2.
Infectious complications are a major cause of morbidity and mortality after heart transplantation (HT). However, the epidemiology and outcomes of these infections in the recent population of adult heart transplant recipients have not been investigated.
We conducted a single-center retrospective study on infectious complications occurring within 180 days following HT on consecutive heart transplant recipients, from January 2011 to June 2015 at Bichat University Hospital in Paris, France. Risk factors for non-viral infections occurring within 8, 30 and 180 days after HT were investigated using competing risk analysis.
Overall, 113 patients were included. Fifty-eight (51%) HTs were high-priority allocations. Twenty-eight (25%) patients had an extracorporeal membrane oxygenation (ECMO) support at the time of transplantation. Ninety-two (81%) patients developed at least one infection within 180 days after HT. Bacterial and fungal infections (n = 181 episodes) occurred in 80 (71%) patients. The most common bacterial and fungal infections were pneumonia (n = 95/181 episodes, 52%), followed by skin and soft tissue infections (n = 26/181, 14%). Multi-drug-resistant bacteria were responsible for infections in 21 (19%) patients. Viral infections were diagnosed in 44 (34%) patients, mostly Cytomegalovirus infection (n = 39, 34%). In multivariate subdistribution hazard model, prior cardiac surgery (subdistribution hazard ratio sHR = 2.7 [95% CI 1.5-4.6] p < 0.01) and epinephrine or norepinephrine at the time of HT (sHR = 2.3 [95% CI 1.1-5.2] p = 0.04) were significantly associated with non-viral infections within 8 days after HT. Prior cardiac surgery (sHR = 2.5 [95% CI 1.4-4.4] p < 0.01), recipient age over 60 years (sHR = 2.0 [95% CI 1.2-3.3] p < 0.01) and ECMO following HT (sHR = 1.7 [95% CI 1.0-2.8] p = 0.04) were significantly associated with non-viral infection within 30 days after HT, as well as within 180 days after HT.
This study confirmed the high rate of infections following HT. Recipient age, prior cardiac surgery and ECMO following HT were independent risk factors for early and late bacterial and fungal infections.
感染性并发症是心脏移植（HT）后发病和死亡的主要原因。然而，近期成年心脏移植受者中这些感染的流行病学及转归尚未得到研究。
我们对2011年1月至2015年6月在法国巴黎比沙医院连续接受心脏移植的受者在HT后180天内发生的感染性并发症进行了单中心回顾性研究。采用竞争风险分析研究HT后8天、30天和180天内发生非病毒感染的危险因素。
共纳入113例患者。58例（51%）HT为高优先级分配。28例（25%）患者在移植时接受体外膜肺氧合（ECMO）支持。92例（81%）患者在HT后180天内发生至少一次感染。80例（71%）患者发生细菌和真菌感染（共181次发作）。最常见的细菌和真菌感染是肺炎（181次发作中95次，52%），其次是皮肤和软组织感染（181次发作中26次，14%）。21例（19%）患者的感染由多重耐药菌引起。44例（34%）患者诊断为病毒感染，主要是巨细胞病毒感染（39例，34%）。在多变量亚分布风险模型中，既往心脏手术（亚分布风险比sHR = 2.7 [95%CI 1.5 - 4.6] p < 0.01）和HT时使用肾上腺素或去甲肾上腺素（sHR = 2.3 [95%CI 1.1 - 5.2] p = 0.04）与HT后8天内的非病毒感染显著相关。既往心脏手术（sHR = 2.5 [95%CI 1.4 - 4.4] p < 0.01）、受者年龄超过60岁（sHR = 2.0 [95%CI 1.2 - 3.3] p < 0.01）和HT后ECMO（sHR = 1.7 [95%CI 1.0 - 2.8] p = 0.04）与HT后30天内以及HT后180天内的非病毒感染显著相关。
本研究证实了HT后感染率较高。受者年龄、既往心脏手术和HT后ECMO是早期和晚期细菌及真菌感染的独立危险因素。
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