Infección en el postoperatorio del transplante cardíacocaracterísticas epidemiológicas e implicación pronóstica

Abstract

OBJECTIVES: The aim of this study was to analyze the incidence, characteristics, and outcome of in-hospital postoperative infections after heart transplantation. METHODS: We conducted an observational, single-center study based on 677 patients who received a heart transplant from 1991 to 2015 and survived the surgical procedure. Demographic, clinical and surgical characteristics of patients were collected, as well as the features of the infectious episodes. In-hospital postoperative infections were identified retrospectively according to the clinical records. Qualitative variables are expressed as a proportion and quantitative variables as mean and standard deviation. Categorical variables were compared using a chi-square or Fisher’s exact test as appropriate. Quantitative variables were compared using a Student’s t-test. Kaplan Meier plots and Cox´s regression were used to assess the survival probability and the cumulative incidence of in-hospital postoperative infection RESULTS: Two hundred and thirty-nine patients (35.3%) developed 348 episodes of infection (2 episodes per 100 patient-days). The most common sources of infection were respiratory tract (n=115, 33%), urinary tract (n=47, 13.5%), bacteremia (n=43, 12.1%), abdominal (n=33, 9.5%) and surgical site (n=25, 7.2%). Enterobacteriaceae (76, 21.8%), Gram-positive cocci (58, 16.7%) and opportunistic germs (69, 19.8%) were the predominant germs. Ninety-five septic episodes were detected with a mean SOFA Score of 9.5±5.3 points. The overall antimicrobial success rate was 96.3%. Surgical management was required in 13.8% of cases. Higher inhospital mortality was observed among infected patients (15.1% vs 10.3%), but this difference was not statistically significant (p=0.067). The one-year survival and events were not different between groups. CONCLUSIONS: In-hospital infections were frequent in the postoperative period after heart transplant and were associated with a poor short-term outcome. Patients who survived sepsis had a similar one-year morbidity and mortality to patients who did not develop an infection.