Published online Jun 18, 2024. doi: 10.5500/wjt.v14.i2.93567
Revised: May 5, 2024
Accepted: May 20, 2024
Published online: June 18, 2024
Processing time: 105 Days and 10.6 Hours
Transplant recipients commonly harbor multidrug-resistant organisms (MDROs), as a result of frequent hospital admissions and increased exposure to antimicrobials and invasive procedures.
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.
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.
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).
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.