Infectious complications following heart transplantation in the era of high-priority allocation and extracorporeal membrane oxygenation
Abstract Background 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. Methods We conducted a sing...
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doaj-50bd68849c0c408cacbe87443ce275b92020-11-25T01:59:05ZengSpringerOpenAnnals of Intensive Care2110-58202019-01-01911910.1186/s13613-019-0490-2Infectious complications following heart transplantation in the era of high-priority allocation and extracorporeal membrane oxygenationStéphanie Pons0Romain Sonneville1Lila Bouadma2Lenka Styfalova3Stéphane Ruckly4Mathilde Neuville5Aguila Radjou6Jordane Lebut7Marie-Pierre Dilly8Bruno Mourvillier9Richard Dorent10Patrick Nataf11Michel Wolff12Jean-François Timsit13Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University HospitalMedical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University HospitalMedical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University HospitalDepartment of Biostatistics, ICUREsearchDepartment of Biostatistics, ICUREsearchMedical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University HospitalMedical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University HospitalMedical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University HospitalDepartment of Anesthesiology, AP-HP, Bichat-Claude Bernard University HospitalMedical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University HospitalDepartment of Cardiac Surgery, AP-HP, Bichat-Claude Bernard University HospitalDepartment of Cardiac Surgery, AP-HP, Bichat-Claude Bernard University HospitalMedical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University HospitalMedical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University HospitalAbstract Background 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. Methods 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. Results 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. Conclusion 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.http://link.springer.com/article/10.1186/s13613-019-0490-2Heart transplantationInfectionsExtracorporeal membrane oxygenationOutcome |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Stéphanie Pons Romain Sonneville Lila Bouadma Lenka Styfalova Stéphane Ruckly Mathilde Neuville Aguila Radjou Jordane Lebut Marie-Pierre Dilly Bruno Mourvillier Richard Dorent Patrick Nataf Michel Wolff Jean-François Timsit |
spellingShingle |
Stéphanie Pons Romain Sonneville Lila Bouadma Lenka Styfalova Stéphane Ruckly Mathilde Neuville Aguila Radjou Jordane Lebut Marie-Pierre Dilly Bruno Mourvillier Richard Dorent Patrick Nataf Michel Wolff Jean-François Timsit Infectious complications following heart transplantation in the era of high-priority allocation and extracorporeal membrane oxygenation Annals of Intensive Care Heart transplantation Infections Extracorporeal membrane oxygenation Outcome |
author_facet |
Stéphanie Pons Romain Sonneville Lila Bouadma Lenka Styfalova Stéphane Ruckly Mathilde Neuville Aguila Radjou Jordane Lebut Marie-Pierre Dilly Bruno Mourvillier Richard Dorent Patrick Nataf Michel Wolff Jean-François Timsit |
author_sort |
Stéphanie Pons |
title |
Infectious complications following heart transplantation in the era of high-priority allocation and extracorporeal membrane oxygenation |
title_short |
Infectious complications following heart transplantation in the era of high-priority allocation and extracorporeal membrane oxygenation |
title_full |
Infectious complications following heart transplantation in the era of high-priority allocation and extracorporeal membrane oxygenation |
title_fullStr |
Infectious complications following heart transplantation in the era of high-priority allocation and extracorporeal membrane oxygenation |
title_full_unstemmed |
Infectious complications following heart transplantation in the era of high-priority allocation and extracorporeal membrane oxygenation |
title_sort |
infectious complications following heart transplantation in the era of high-priority allocation and extracorporeal membrane oxygenation |
publisher |
SpringerOpen |
series |
Annals of Intensive Care |
issn |
2110-5820 |
publishDate |
2019-01-01 |
description |
Abstract Background 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. Methods 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. Results 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. Conclusion 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. |
topic |
Heart transplantation Infections Extracorporeal membrane oxygenation Outcome |
url |
http://link.springer.com/article/10.1186/s13613-019-0490-2 |
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