title: Bloodstream infection in heart transplant recipients: 12-year experience at a university hospital in Taiwan.
abstract: OBJECTIVE
  Bloodstream infection (BSI) is a well-recognized problem and it affects 10-50% of solid organ transplant recipients. The purpose of this study was to assess the incidence and prognosis of BSI in heart transplant recipients at our hospital.
  
  
  METHODS
  The study is a retrospective chart review.
  
  
  RESULTS
  We diagnosed 101 episodes of BSI in 73 out of 306 heart transplant patients (24%) during the 12-year study period. BSI occurred at a median of 191 days (range 1-3376) after transplant and 50% occurred within 6 months after transplant. Most BSI episodes were nosocomial (73%), especially those occurring within the first month (94%). As far as pathogen was concerned, Gram-negative bacteria predominated (57%), followed by Gram-positive bacteria (34%), fungus (5%), anaerobics (2%), and cryptococcus (2%). Overall 30-day mortality rate was 30%. Death occurred in 36% (13/36) of the patients with early-onset BSI, 14% (2/14) of the patients with BSI in months 2-6, and 29% (15/51) of the patients with late-onset BSI. Mortality rate was over 50% in those patients with Pseudomonal infection, fungal infection, cryptococcal infection of central nervous system, lung infection, and severe sepsis. Compared to Western series, there was a high incidence of infections caused by Enterobacter species and Acinetobacter baumannii.
  
  
  CONCLUSIONS
  There was a high incidence of BSI after heart transplantation in Taiwan, especially infections caused by Enterobacter species and A. baumannii. Mortality was high in patients with infection caused by Pseudomonas, Candida, and Cryptococcus and in patients with severe sepsis.
authors: Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. ronbin@ntuh.gov.tw
authors: Ron-Bin
authors: RB
authors: Hsu
authors: Chung-I
authors: CI
authors: Chang
authors: Chi-Tai
authors: CT
authors: Fang
authors: Shan-Chwen
authors: SC
authors: Chang
authors: Shoei-Shen
authors: SS
authors: Wang
authors: Shu-Hsun
authors: SH
authors: Chu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis / Q000379:methods; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D004812:Epidemiologic Methods; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D016027:Heart Transplantation / Q000009:adverse effects*; D006785:Hospitals, University; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods; D007223:Infant; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011184:Postoperative Period; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult