An Outbreak of Mediastinitis Among Heart Transplant Recipients Apparently Related to a Change in the United Network for Organ Sharing Guidelines

Samuel, Rafik; Axelrod, Peter; John, K. St.; Fekete, Thomas; Alexander, Sharon; McCarthy, James; Truant, Allan L.; Todd, Barbara; Furukawa, Satoshi; Eisen, Howard J.; Spotnitz, William D.

doi:10.1086/502069

Cited by 8 publications

(4 citation statements)

References 21 publications

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“…It may be that the time when mediastinitis occurs and the time that significant immunosuppression occurs are not concordant. Post‐surgical mediastinitis typically occurs within a month after OHT (1, 2, 6). Cellular immunity wanes significantly after the first month, which predisposes patients to mold infections (8).…”

Section: Discussionmentioning

confidence: 99%

“…Mediastinitis following OHT has been described in the literature (1, 2, 6). Two studies (1, 2), describe the mediastinitis experience in heart transplant recipients at their centers.…”

Section: Review Of the Literaturementioning

confidence: 99%

“…Two studies (1, 2), describe the mediastinitis experience in heart transplant recipients at their centers. The third (6) describes a mediastinitis outbreak in heart transplant recipients in 1999 at our center. In total, 34 cases of mediastinitis are described.…”

Section: Review Of the Literaturementioning

confidence: 99%

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Aspergillus mediastinitis following orthotopic heart transplantation: case report and review of the literature

Levin

Suh

Beltramo

et al. 2004

Transplant Infectious Dis

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Section: Discussionmentioning

confidence: 99%

“…Mediastinitis following OHT has been described in the literature (1, 2, 6). Two studies (1, 2), describe the mediastinitis experience in heart transplant recipients at their centers.…”

Section: Review Of the Literaturementioning

confidence: 99%

See 1 more Smart Citation

Aspergillus mediastinitis following orthotopic heart transplantation: case report and review of the literature

Levin

Suh

Beltramo

et al. 2004

Transplant Infectious Dis

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“…3 Aspergillus fungal mediastinitis has been reported after open-heart procedures, such as coronary artery bypass operations, but it is extremely rare after heart transplantation. 2,4 This could be because postsurgical mediastinitis usually occurs within 30 days, [4][5][6] but the significant waning of cellular immunity that makes a patient increasingly vulnerable to fungal infection occurs more than 30 days postoperatively. 7 Because the 2 events are not concordant, fungal mediastinitis is unlikely to occur.…”

Section: Discussionmentioning

confidence: 99%

Aspergillus Mediastinitis after Orthotopic Heart Transplantation: A Case Report

Ahmed¹,

Almanfi²,

Aftab³

et al. 2015

Texas Heart Institute Journal

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The U.S. Centers for Disease Control and Prevention defines Aspergillus mediastinitis as the presence of a positive culture result from a mediastinal sample, plus one of the following: 1) fever higher than 38 °C, or 2) chest pain or sternal instability with purulent effusion in the mediastinum or positive culture results from surgically obtained samples or blood.1 Of all cardiothoracic procedures, orthotopic heart transplantation (OHT) is associated with the highest risk of mediastinitis (including bacterial and fungal), with infection rates of 2.5% to 6%.3 A review of the literature reveals only 3 cases in which Aspergillus mediastinitis occurred after OHT; all 3 cases involved A. fumigatus. We describe what we believe to be the first case of Aspergillus calidoustus mediastinitis after OHT. Case ReportA 55-year-old woman was admitted for OHT. Her medical history was notable for ischemic cardiomyopathy, as well as for hypertension, dyslipidemia, coronary artery disease, myocardial infarction, ventricular tachycardia, paroxysmal atrial fibrillation, and chronic kidney disease. Her surgical history included implantation of a left ventricular assist device (LVAD), resection of a left ventricular aneurysm, and implantation of a biventricular defibrillator. She had no history of infectious sequelae with her LVAD. During the OHT procedure, the patient was coagulopathic and needed several units of different blood products. Her chest was temporarily closed at the end of the operation and was permanently closed 3 days later.Postoperatively, she had prolonged respiratory and renal failure that necessitated ventilator support, hemodialysis, and inotropic and vasopressor support. Despite the new heart, she also needed further circulatory support, including an intra-aortic balloon pump. Two weeks postoperatively, she underwent a tracheostomy. Five weeks postoperatively, she developed fever with an elevated white blood cell count. Physical examination revealed tenderness, erythema, and sternal wound drainage. A computed tomographic scan revealed a mediastinal fluid collection and thereby confirmed the diagnosis. Surgical drainage of the fluid and aggressive débridement of the infected sternum were performed. During débridement, we locally irrigated the infected tis-

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Operative Medizin

Grossart

Praktische Krankenhaushygiene Und Umweltschutz

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An Outbreak of Mediastinitis Among Heart Transplant Recipients Apparently Related to a Change in the United Network for Organ Sharing Guidelines

Abstract: 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.

Cited by 8 publications

References 21 publications

Aspergillus mediastinitis following orthotopic heart transplantation: case report and review of the literature

Aspergillus mediastinitis following orthotopic heart transplantation: case report and review of the literature

Aspergillus Mediastinitis after Orthotopic Heart Transplantation: A Case Report

Operative Medizin

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