Universal Time: 17:46  |  Local Time: 17:46 (0h GMT)
Select your timezone:
Room: E-Poster Hall

P-16.15 Infectious complications early-term after heart transplantation

Maria Simonenko, Russian Federation

Cardiologist, Transplant Physician, Clinical Research Fellow
Heart Transplantation
Almazov National Medical Research Centre

Abstract

Infectious complications early-term after heart transplantation

Maria Simonenko1,2, Petr Fedotov3, Larisa Vasilieva4, Yulia Sazonova5,7, Karina Monosova6, Maria Bortsova7, Alexander Marichev8, Vadim Rubinchik9, Andrei Bautin10, Maria Sitnikova11, German Nikolaev5, Mikhail Gordeev12, Mikhail Karpenko13.

1Heart Transplantation Department, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; 2Cardiopulmonary Exercise Test SRL, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; 3Heart Failure SRL, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; 4Internal Disease Department, First I.P. Pavlov Saint-Petersburg State Medical University, Saint-Petersburg, Russian Federation; 5Thoracic Surgery SRL, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; 6Clinical pharmacology, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; 7Cardio Department №8, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; 8ICU №7, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; 9ICU №2, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; 10Anesthesiology and Resuscitation SRL, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; 11Heart Failure Research Department, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; 12Cardiothoracic Surgery Research Department, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; 13Scientific Clinical Council, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation

Purpose: to estimate the frequency and risk factors of infectious episodes (IEs) development early-term after heart transplantation (HTx).
Materials and Methods: From January 2010 to January 2020 we performed 140 orthotopic HTx (mean age - 47±14 year-old; 104 – male, 36 – female), 13% (n=18: n=3 - underwent an implantation of 2 MCSs) of them were bridged to transplant with the following mechanical circulatory support (MCS): ECMO (n=12), Berlin Heart “EXCOR” (n=8), LVAD (n=1). Most of recipients (71%, n=99) were awaiting HTx in heart failure (HF) department (n=83) or ICU (n=16) while others (29%, n=41) have been discharged from a hospital and followed-up in outpatient HF department. And 34 patients had IEs (n=13 – bacterial pneumonia, n=5 – bronchitis) while awaiting HTx (30 days prior to HTx) in inpatient department. Cefuroxime was used as a surgical antimicrobial prophylaxis in 85% (n=119) cases. Recipients were managed with triple-drug immunosuppression: tacrolimus, mycophenolic acid, steroids and induction (n=116 – Basiliximab, n=20 – Thymoglobulin). As prophylaxis of infections we prescribed all of them: Valgancyclovir (since 10th post-transplant day), Trimethoprim/Sulfamethoxazole and Nystatin. We retrospectively analyzed outcomes in ICU, the frequency of IEs development and the mortality rate early-term after HTx (30 days).
Results: After HTx most of patients were on ventilator support for about 1-2 days (79%, n=110) and spent in ICU than 10 days (65%, n=91), including 7,9% (n=11) of those who required post-transplant ECMO implantation due to right heart failure (RHF). IEs (n=97) developed in 56% (n=78) of recipients: 71% (n=69) – were bacterial, 27% (n=26) – fungal and 2% (n=2) – viral. The following IEs were diagnosed: pneumonia (n=29: n=3 - Aspergillus fumigatus), acute bronchitis (n=24), rhinopharyngitis/frontal sinusitis (n=5), urinary tract infection (n=27), orchiepididymitis (n=2) and others (n=10). IEs were caused by Klebsiella pneumonia (n=26), Pseudomonas aeruginosa (n=14), Enterococcus faecalis (n=6), Streptococcus Spp. (n=5), Enterobacter Sp. (n=2) etc. According to blood results of polymerase chain reaction (PCR), CMV was positive in 40 patients and EBV – in 37 without any other symptoms. In dynamic PCR was checked in all recipients. We found positive correlations between awaiting HTx in ICU department and pneumonia post-transplant development (r=0.356; p<0.001); between long stay on ventilator support and fungal infections (r=0.381; p=0.002) and pneumonia development (r=0.0547; p<0.001). In addition, 13 (9,3%) of patients died during 30 days after HTx and 2 more – before turning 2 months; their death was associated with infectious complications and sepsis in 60% (n=9).
Conclusion: During 30 days after HTx IEs developed in 56% of recipients with a prevalence of bacterial infections (71%) associated with Klebsiella pneumonia or Pseudomonas aeruginosa. Most frequent infectious locations were respiratory and urinary tracts.

Comments

There are no comments yet...

WebApp Sponsor

© 2022 TTS 2020