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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Incidence, risk factors and clinical outcome of multidrug-resistant organisms after heart transplantation
Sophia Hatzianastasiou, Paraskevas Vlachos, Georgios Stravopodis, Dimitrios Elaiopoulos, Afentra Koukousli, Josef Papaparaskevas, Themistoklis Chamogeorgakis, Kyrillos Papadopoulos, Theodora Soulele, Despoina Chilidou, Kyriaki Kolovou, Aggeliki Gkouziouta, Michail Bonios, Stamatios Adamopoulos, Stavros Dimopoulos
Sophia Hatzianastasiou, Georgios Stravopodis, Afentra Koukousli, Josef Papaparaskevas, Microbiology Department and Infection Control Office, Onassis Cardiac Surgery Center, Athens 17674, Greece
Paraskevas Vlachos, Themistoklis Chamogeorgakis, Despoina Chilidou, Aggeliki Gkouziouta, Michail Bonios, Stamatios Adamopoulos, Heart Transplantation Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
Dimitrios Elaiopoulos, Kyrillos Papadopoulos, Theodora Soulele, Kyriaki Kolovou, Stavros Dimopoulos, Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
Author contributions: Hatzianastasiou S performed the research and wrote the paper; Vlahos P, Stravopodis G, Chilidou D and Koukousli A retrieved patient data and contributed to the analysis; Elaiopoulos D, Papadopoulos K, Soulele T, Kolovou K, Chamogeorgakis T, Gkouziouta A, Bonios M and Adamopoulos S provided clinical advice; Papaparaskevas J supervised the report, and Dimopoulos S designed the research, supervised the report and gave the final approval.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Onassis Cardiac Surgery Center.
Informed consent statement: Patients were not required to give informed consent to the study, because the analysis used anonymous clinical data that were obtained after each patient agreed to heart transplantation by written consent.
Conflict-of-interest statement: The authors have no financial relationships or other conflict of interest to disclose with regard to this study.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Stavros Dimopoulos, MD, PhD, Chief Doctor, Director, Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, 356 Syggrou Av, Athens 17674, Greece. stdimop@gmail.com
Received: February 29, 2024
Revised: May 5, 2024
Accepted: May 20, 2024
Published online: June 18, 2024
Processing time: 105 Days and 10.6 Hours
BACKGROUND
Transplant recipients commonly harbor multidrug-resistant organisms (MDROs), as a result of frequent hospital admissions and increased exposure to antimicrobials and invasive procedures.
AIM
To investigate the impact of patient demographic and clinical characteristics on MDRO acquisition, as well as the impact of MDRO acquisition on intensive care unit (ICU) and hospital length of stay, and on ICU mortality and 1-year mortality post heart transplantation.
METHODS
This retrospective cohort study analyzed 98 consecutive heart transplant patients over a ten-year period (2013-2022) in a single transplantation center. Data was collected regarding MDROs commonly encountered in critical care.
RESULTS
Among the 98 transplanted patients (70% male), about a third (32%) acquired or already harbored MDROs upon transplantation (MDRO group), while two thirds did not (MDRO-free group). The prevalent MDROs were Acinetobacter baumannii (14%), Pseudomonas aeruginosa (12%) and Klebsiella pneumoniae (11%). Compared to MDRO-free patients, the MDRO group was characterized by higher body mass index (P = 0.002), higher rates of renal failure (P = 0.017), primary graft dysfunction (10% vs 4.5%, P = 0.001), surgical re-exploration (34% vs 14%, P = 0.017), mechanical circulatory support (47% vs 26% P = 0.037) and renal replacement therapy (28% vs 9%, P = 0.014), as well as longer extracorporeal circulation time (median 210 vs 161 min, P = 0.003). The median length of stay was longer in the MDRO group, namely ICU stay was 16 vs 9 d in the MDRO-free group (P = 0.001), and hospital stay was 38 vs 28 d (P = 0.006), while 1-year mortality was higher (28% vs 7.6%, log-rank-χ2: 7.34).
CONCLUSION
Following heart transplantation, a predominance of Gram-negative MDROs was noted. MDRO acquisition was associated with higher complication rates, prolonged ICU and total hospital stay, and higher post-transplantation mortality.
Core Tip: We evaluated multidrug-resistant organisms (MDROs) in heart transplantation and their impact on patient outcome. Carbapenem-resistant Gram-negative bacteria predominated, in line with the epidemiologic pattern in south-eastern Europe. Among comorbidities, renal failure and higher body mass index were shown to be important risk factors pre-transplantation. Surgical and medical complications were shown to be predictive of MDRO acquisition, while no association was shown for the type of cardiomyopathy, for the mode of admission [from home, ward or intensive care unit (ICU)] or for previous cardiac surgery. MDRO presence was associated with longer ICU and hospital length of stay, and higher ICU-mortality and 1-year mortality.
