An outbreak of mediastinitis among heart transplant recipients apparently related to a change in the united network for organ sharing guidelines.
OBJECTIVE
To describe an outbreak of mediastinitis in heart transplant recipients.


METHODS
Retrospective and contemporaneous cohort


METHODS
Urban tertiary-care university hospital with a large cardiac transplantation program.


METHODS
Heart transplant recipients.


METHODS
Modifications of donor harvest technique; procedures aimed at decreasing skin and mucosal bacterial colonization; strict aseptic technique in the intensive care unit; and aggressive policing of established infection control practices.


RESULTS
In April 1999, mediastinitis rates among heart transplant recipients increased abruptly from a baseline of 6 cases per 100 procedures to sequential quarterly rates of 22, 31, and 50 cases per 100 procedures, whereas infection rates in other cardiac operations were unchanged. Bacteria causing these infections were multidrug-resistant "nosocomial" organisms. The epidemic occurred 2 months after a change in the United Network for Organ Sharing organ allocation algorithm. This change resulted in an increase in the duration of preoperative hospitalization from a median of 52 to 79 days (P = .008) and may have promoted prolonged hospitalization of patients with high illness severity. Aggressive multidisciplinary interventions were temporally associated with a return to preoperative mediastinitis rates without changing length of hospitalization prior to transplantation.


CONCLUSIONS
Changes in organ allocation for transplant that prolong waiting time in the hospital and alter illness acuity may lead to increased rates of postoperative infection. Measures to limit bacterial colonization may be a helpful countervailing strategy.
Samuel
Rafik
R
Section of Infectious Diseases, Temple University Hospital, Philadelphia, Pennsylvania, 19140, USA.
Axelrod
Peter
P
John
Keith St
KS
Fekete
Thomas
T
Alexander
Sharon
S
McCarthy
James
J
Truant
Allan
A
Todd
Barbara
B
Furukawa
Satoshi
S
Eisen
Howard
H
Spotnitz
William
W
D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D004196:Disease Outbreaks / Q000517:prevention & control; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D017053:Infection Control / Q000379:methods; D007902:Length of Stay; D008480:Mediastinitis / Q000453:epidemiology* / Q000517:prevention & control; D009873:Operating Rooms / Q000592:standards; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014019:Tissue Donors