title: Epidemiology and outcomes of deep surgical site infections following lung transplantation.
abstract: We conducted a retrospective study of deep surgical site infections (SSIs) among consecutive patients who underwent lung transplantation (LTx) at a single center from 2006 through 2010. Thirty-one patients (5%) developed SSIs at median 25 days after LTx. Empyema was most common (42%), followed by surgical wound infections (29%), mediastinitis (16%), sternal osteomyelitis (6%), and pericarditis (6%). Pathogens included Gram-positive bacteria (41%), Gram-negative bacteria (41%), fungi (10%) and Mycobacterium abscessus, Mycoplasma hominis and Lactobacillus sp. (one each). Twenty-three percent of SSIs were due to pathogens colonizing recipients' native lungs at time of LTx, suggesting surgical seeding as a source. Patient-related independent risk factors for SSIs were diabetes and prior cardiothoracic surgery; procedure-related independent risk factors were LTx from a female donor, prolonged ischemic time and number of perioperative red blood cell transfusions. Mediastinitis and sternal infections were not observed among patients undergoing minimally invasive LTx. SSIs were associated with 35% mortality at 1 year post-LTx. Lengths of stay and mortality in-hospital and at 6 months and 1 year were significantly greater for patients with SSIs other than empyema. In conclusion, deep SSIs were uncommon, but important complications in LTx recipients because of their diverse microbiology and association with increased mortality.
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: R K
authors.initials: RK
authors.lastname: Shields
authors.forename: C J
authors.initials: CJ
authors.lastname: Clancy
authors.forename: L R
authors.initials: LR
authors.lastname: Minces
authors.forename: N
authors.initials: N
authors.lastname: Shigemura
authors.forename: E J
authors.initials: EJ
authors.lastname: Kwak
authors.forename: F P
authors.initials: FP
authors.lastname: Silveira
authors.forename: R C
authors.initials: RC
authors.lastname: Abdel-Massih
authors.forename: J K
authors.initials: JK
authors.lastname: Bhama
authors.forename: C A
authors.initials: CA
authors.lastname: Bermudez
authors.forename: J M
authors.initials: JM
authors.lastname: Pilewski
authors.forename: M
authors.initials: M
authors.lastname: Crespo
authors.forename: Y
authors.initials: Y
authors.lastname: Toyoda
authors.forename: M H
authors.initials: MH
authors.lastname: Nguyen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality*; D006090:Gram-Negative Bacteria / Q000472:pathogenicity; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D006094:Gram-Positive Bacteria / Q000472:pathogenicity; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D006801:Humans; D008171:Lung Diseases / Q000150:complications* / Q000401:mortality / Q000601:surgery; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Empyema; lung transplant; surgical site infection