title: Infective endocarditis following orthotopic heart transplantation: 10 cases and a review of the literature.
abstract: BACKGROUND
  Infective endocarditis is a known complication of cardiac transplantation. However, published information has been limited to case reports and small case series.
  
  
  METHODS
  Cardiac transplantation has been performed at Temple University Hospital since 1983. We identified transplant patients with ICD-9 codes for endocarditis or bacteremia. A diagnosis of endocarditis required fulfillment of the Duke criteria and presence of a vegetation. Clinical and microbiologic data were collected. Demographic and survival information were compared with heart transplant recipients without endocarditis. We reviewed all previously published cases using a MEDLINE search.
  
  
  RESULTS
  Ten of 659 heart transplant recipients had endocarditis (1.5%, 187 cases per 100,000 person years). Mitral and tricuspid valves were involved predominantly. No patient had aortic valve infection. Patients with tricuspid valve infection had a greater median number of endomyocardial biopsies (n=23) than those with mitral valve infection (n=9, P=0.10). The major pathogens were Staphylococcus aureus (4 cases) and Aspergillus fumigatus (3 cases). Factors associated with S. aureus infection were new hemodialysis catheters, cellulitis, and a contaminated donor organ. All patients with A. fumigatus had antecedent cytomegalovirus viremia and disseminated fungal infection, including endophthalmitis. Endocarditis-related mortality was 80%. Median survival after transplant was 1.4 years in patients with endocarditis, compared with 9.3 years in other heart transplant recipients (P<0.001).
  
  
  CONCLUSIONS
  Endocarditis is substantially more common in heart transplant recipients than in general populations. Frequent central venous catheter access and multiple endomyocardial biopsies appear to predispose to infection. Aspergillus is a common pathogen and endocarditis follows infection elsewhere. The prognosis of post-cardiac transplant endocarditis is poor.
authors.affiliation: Section of Infectious Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA.
authors.forename: S
authors.initials: S
authors.lastname: Sherman-Weber
authors.forename: P
authors.initials: P
authors.lastname: Axelrod
authors.forename: B
authors.initials: B
authors.lastname: Suh
authors.forename: S
authors.initials: S
authors.lastname: Rubin
authors.forename: D
authors.initials: D
authors.lastname: Beltramo
authors.forename: J
authors.initials: J
authors.lastname: Manacchio
authors.forename: S
authors.initials: S
authors.lastname: Furukawa
authors.forename: T
authors.initials: T
authors.lastname: Weber
authors.forename: H
authors.initials: H
authors.lastname: Eisen
authors.forename: R
authors.initials: R
authors.lastname: Samuel
mesh_terms: D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000209:etiology; D004696:Endocarditis / Q000209:etiology* / Q000382:microbiology / Q000401:mortality; D004697:Endocarditis, Bacterial / Q000209:etiology; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies