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

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.

Background: Infection is a major cause of morbidity and mortality after heart transplantation (HT). Little information about its importance in the immediate post-operative period is available. The aim of this study was to analyze the characteristics, incidence, and outcomes of in-hospital post-operative infections after HT. Methods: We conducted an observational, single-center study based on 677 adults who underwent HT from 1991 to 2015 and who survived the surgical intervention. In-hospital post-operative infections were identified retrospectively according to the medical finding in the clinical records. Results: Over a mean hospital stay of 24.5 days, 239 patients (35.3%) developed 348 episodes of infection (2 episodes per 100 patient-days). The most common sources of infection were those related to invasive procedures (respiratory infections, 115 [33%]; urinary tract infections, 47 [13.5%]; bacteremia, 42 [12.1%]; surgical site infections, 25 [7.2%]), in addition to abdominal focus (33, 9.5%). Enterobacteriaceae (76, 21.8%) and gram-positive cocci (58, 16.7%) were the predominant germs, although opportunistic infections were not infrequent (69, 19.8%). Ninety-five septic episodes were detected with a mean Sequential Organ Failure Assessment Score of 9.5 ± 5.3 points, with hemodynamic failure being the most severe organ dysfunction and renal dysfunction the most frequent one. Management included broad-spectrum antibiotics in 48.8% of episodes and surgical management in 13.8%. The overall antimicrobial success rate was 96.3%. Higher in-hospital 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 patients suffering from a post-operative infection and those who did not. Conclusions: In-hospital infections were frequent in the post-operative period after HT and were associated with a poor short-term outcome. Patients who survived sepsis had a similar one-year morbidity and mortality compared with patients who did not develop an infection.

Coinfección bacteriana en el paciente COVID-19 crítico: incidencia, impacto y necesidad de tratamiento antibiótico / Bacterial coinfection in the critically-ill COVID-19 patient: incidence, impact and need for antimicrobial therapy

Objetivos. Evaluar la frecuencia de coinfección bacteriana al ingreso en UCI en pacientes con neumonía por SARS-CoV-2, su microbiología e impacto en el pronóstico. El objetivo secun dario fue identificar factores de riesgo de coinfección al ingreso. Métodos. Estudio retrospectivo, se incluyeron pacientes con neumonía por SARS-CoV-2 ingresados en UCI. Definimos coinfección bacteriana por síntomas respiratorios, datos radioló gicos, resultados microbiológicos positivos y clínicamente signi ficativos en muestras obtenidas en las primeras 48 h de ingreso y/o una determinación de procalcitonina ≥ 0,5 ng/mL en las pri meras 48 h. Evaluamos variables demográficas, comorbilidades, datos de la infección por SARS-CoV-2, scores de gravedad, tra tamientos recibidos, necesidad de soporte respiratorio y resulta dos (estancia y mortalidad durante el ingreso en UCI y hospital). Resultados. Se analizaron 182 pacientes, 62 (34.1%) con coinfección bacteriana. La microbiología más frecuente fue S. pneumoniae y M. pneumoniae. El 96.1% de los pacientes re cibieron antibioterapia al ingreso, 98,9% corticoides, 27,5% tocilizumab y 7,7% remdesivir. El 85.7% necesitó ventilación mecánica invasiva. La puntuación en SOFA (OR: 1,315, IC 95% 1,116-1,548) y el retraso en el ingreso en UCI (OR: 0,899, IC 95% 0,831-0,972) se relacionaron con el riesgo de coinfección. La coinfección bacteriana aumenta el riesgo de muerte en el hospital (OR 2,283; IC 95% 1,011-5,151; p=0,047). Conclusiones. La coinfección bacteriana es frecuente en pacientes COVID ingresados en UCI y aumenta el riesgo de muerte. No es posible identificar con seguridad, en el momen to de ingreso, qué pacientes no se benefician de tratamiento antibiótico (AU)

ion upon ICU admission in SARS-CoV-2 pneumonia patients, its microbiology, and impact on prognosis.The secondary ob jective was to identify risk factors for coinfection on admis sion. Methods. Retrospective study, including patients with SARS-CoV-2 pneumonia admitted to the ICU.We defined bac terial coinfection by respiratory symptoms, radiological data, positive and clinically significant microbiological results in samples obtained in the first 48 h of admission and/or a de termination of procalcitonin ≥ 0.5 ng/mL in the first 48 h.We evaluated demographic variables, comorbidities, SARS-CoV-2 infection data, severity scores, treatments received, need for respiratory support and outcomes (ICU and hospital mortality). Results. A total of 182 patients were analyzed, 62 (34.1%) with bacterial coinfection.The most frequent microbiology was S. pneumoniae and M. pneumoniae.96.1% of the patients re ceived antibiotic therapy on admission, 98.9% corticosteroids, 27.5% tocilizumab, and 7.7% remdesivir.85.7% required inva sive mechanical ventilation.The SOFA score (OR: 1.315, 95% CI 1.116-1.548) and the delay in ICU admission (OR: 0.899, 95% CI 0.831-0.972) were related to the risk of coinfection.Bacterial coinfection increases the risk of death in hospital (OR 2.283; 95% CI 1.011.5.151; p=0.047). Conclusions. Bacterial coinfection is common in COVID patients admitted to the ICU and increases the risk of death.It is not possible to identify with certainty, at the time of admis sion, which patients do not benefit from antibiotic treatment (AU)