In‐hospital postoperative infection after heart transplantation: Risk factors and development of a novel predictive score

Abstract

Introduction: Infection is one of the most significant complications following heart transplantation (HT). The aim of this study was to identify specific risk factors for early postoperative infections in HT recipients, and to develop a multivariable predictive model to identify HT recipients at high risk.Methods: A single-center, observational, and retrospective study was conducted.The dependent variable was in-hospital postoperative infection. We examined demographic and epidemiological data from donors and recipients, surgical features, and adverse postoperative events as independent variables. Backwards, stepwise multivariable logistic regression with a P-value < 0.05 was used to identify clinical factors independently associated with the risk of in-hospital postoperative infections following HT.Results: Six hundred seventy-seven patients were included in this study. During the in-hospital postoperative period, 348 episodes of infection were diagnosed in 239 (35.9%) patients. Seven variables were identified as independent clinical predictors of early postoperative infection after HT: history of diabetes mellitus, previous sternotomy, preoperative mechanical ventilation, primary graft failure, major surgical bleeding, use of mycophenolate mofetil, and use of itraconazole. Based on the results of multivariable models, we constructed a 7-variable (8-point) score to predict the risk of in-hospital postoperative infection in HT recipients, which showed a reasonable ability to predict the risk of in-hospital postoperative infection in this population.Prospective external validation of this new score is warranted to confirm its clinical applicability. Conclusions:In-hospital postoperative infection is a common complication after HT, affecting 35% of patients who underwent this procedure at our institution. Diabetes mellitus, previous sternotomy, preoperative mechanical ventilation, primary graft failure, major surgical bleeding, use of mycophenolate mofetil, and itraconazole were all independent clinical predictors of early postoperative infection after HT.

In-Hospital Post-Operative Infection after Heart Transplantation: Epidemiology, Clinical Management, and Outcome

“…This fact contradicts the results of studies focused on overall infections (not only in-hospital episodes) that expose a reduction of the incidence and mortality of infections over time related to changes in immunosuppression [8]. This difference is reasonable because factors influencing in-hospital infections go beyond immunosuppressants and those factors suffer a simultaneous increment in our series [44].…”

Infections in the first year after heart transplantation in a Latin American country

“…The percentage of individuals on invasive mechanical ventilation before transplantation was also higher (15.19% vs. 1.9% globally), which may cause a higher incidence of early infections and, therefore, an increase in mortality due to infections. 2,20 Bacteria caused most infections in our study, similar to posttransplant infections reported in China, Peru, and the United States. and Enterococcus spp (6.62%).…”

“…One possible reason for the differences in mortality rates may be the higher percentage (56%) of patients admitted to ourbrk hospital before transplant; 50% of patients were in the ICU compared to 44% globally. The percentage of individuals on invasive mechanical ventilation before transplantation was also higher (15.19% vs. 1.9% globally), which may cause a higher incidence of early infections and, therefore, an increase in mortality due to infections 2,20 …”

Distribution and resistance of pathogens in infected patients within 1 year after heart transplantation

“…In our study, the risk factors related to the occurrence of infections within 1 year after HT included diabetes and antibiotics treatment within 1 month before transplant. Similarly, previous studies reported that diabetes and pretransplant therapies are associated with early postoperative infections in HT recipients (Fernández-Ugidos et al, 2019;Pons et al, 2019); besides, previous studies also reported that recipient age over 60 years, prior cardiac surgery, preoperative mechanical ventilation, primary graft failure, major surgical bleeding and post-transplant therapies are associated with early postoperative infections in HT recipients (Fernández-Ugidos et al, 2019;Pons et al, 2019).…”

“…To identify risk factors associated with infections that occur within 1 year after HT, univariable and multivariable logistic regression models were used. Nine variables were chosen for univariable analysis on the basis of previous findings (Alsaeed and Husain, 2019;Fernández-Ugidos et al, 2019;Pons et al, 2019) and clinical constraints; then, variables yielding p < .10 in univariate analysis were included in multivariable logistic regression models. The statistical analyses and graphics were performed with IBM SPSS 25.0 (SPSS Inc, Armonk, NY).…”