Post-operative nosocomial infections after lung and heart transplantation.
BACKGROUND
Thoracic transplant recipients appear to be at high risk for post-operative infections. Therefore, we investigated the incidence and risk factors of post-operative nosocomial infections (NIs) in lung and heart transplant recipients.


METHODS
From January 2002 to December 2003, a cohort of 208 consecutive thoracic transplant recipients (137 lung transplants [LTx], 51 heart transplants [HTx] and 20 combined transplants [CLTx]) were analyzed for post-operative infections and in-hospital mortality. NIs were determined according to CDC definitions. Uni- and multivariate risk factor analyses were performed.


RESULTS
Of the 157 NIs, 59 were pneumonia (37.6%), 34 primary sepsis (21.6%), 34 urinary tract (21.6%) and 30 surgical site (19.1%). Despite a total NI incidence of 75.5%, more importantly 56.3% of all patients remained free from any infection. CLTx patients had a higher risk of developing NIs (odds ratio [OR] 4.97; 95% confidence interval [CI] 1.74 to 15.34). Risk factors for NIs were volume reduction procedures in LTx (OR 2.6; 95% CI 1.13 to 6.30) and re-do Tx (OR 5.25; 95% CI 1.41 to 26.8). In LTx patients, pre-operative colonization with gram-negative rods was found to be a risk factor for post-transplant pneumonia (OR 3.7; 95% CI 1.19 to 11.37). Presence of NI (OR 2.53; 95% CI 1.07 to 6.25) was a risk factor for mortality, as was cystic fibrosis (OR 3.20; 95% CI 1.27 to 7.92) and ventilation prior to transplantation (OR 4.00; 95% CI 1.28 to 12.09).


CONCLUSIONS
The mortality risk associated with NIs requires close infection surveillance for developing specific preventive anti-infection strategies.
Mattner
Frauke
F
Institute of Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany. mattner.frauke@mh-hannover.de
Fischer
Stefan
S
Weissbrodt
Hartmut
H
Chaberny
Iris F
IF
Sohr
Dorit
D
Gottlieb
Jens
J
Welte
Tobias
T
Henke-Gendo
Cornelia
C
Gastmeier
Petra
P
Strueber
Martin
M
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000956:Antigens, Viral / Q000097:blood; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003428:Cross Infection / Q000150:complications; D003550:Cystic Fibrosis / Q000150:complications; D003587:Cytomegalovirus / Q000276:immunology; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D016027:Heart Transplantation; D017052:Hospital Mortality; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000382:microbiology; D011183:Postoperative Complications; D018805:Sepsis / Q000209:etiology; D013530:Surgical Wound Infection / Q000382:microbiology; D014552:Urinary Tract Infections / Q000382:microbiology
D000956:Antigens, Viral