The Challenge of Bacterial Infections During Intensive Care Unit Stay After Heart Transplantation.

IF 2.6 4区医学 Q3 IMMUNOLOGY

Transplant Infectious Disease Pub Date : 2025-04-20 DOI:10.1111/tid.70031

Rita Minucci, Annalisa De Silvestri, Patrizia Cambieri, Marta Corbella, Carlo Pellegrini, Silvia Roda, Chiara Dezza, Stefano Pelenghi, Raffaele Bruno, Mirko Belliato, Elena Seminari

{"title":"The Challenge of Bacterial Infections During Intensive Care Unit Stay After Heart Transplantation.","authors":"Rita Minucci, Annalisa De Silvestri, Patrizia Cambieri, Marta Corbella, Carlo Pellegrini, Silvia Roda, Chiara Dezza, Stefano Pelenghi, Raffaele Bruno, Mirko Belliato, Elena Seminari","doi":"10.1111/tid.70031","DOIUrl":null,"url":null,"abstract":"Background: Infections occurring in the early post-heart transplant (HT) period heavily contribute to morbidity and mortality. Our goal is to evaluate the incidence of hospital-acquired pneumonia/ventilator-associated pneumonia (HAP/VAPs) and/or bloodstream infections (BSIs) after HT during the intensive care unit (ICU) stay and identify their associated risk factors in our tertiary hospital.Methods: Observational prospective study including all adult patients who consecutively underwent HT from January 1, 2015 to August 31, 2023 at Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. HAP/VAPs and BSIs diagnosed during ICU were included in the analysis.Results: A total of 106 patients were included, 38 of whom had at least one infectious episode (35.8%), for a total of 57 independent episodes and their incidence was 2.2 per 100 days (95% CI 1.7-2.8). Length of ICU stay was 8 days (IQR: 6-11) for patients without infectious events and 27 days (IQR 14-52) for those with infectious events (p < 0.001). Gram-negative bacteria were associated with 62.8% of BSIs (mainly Enterobacterales) and with 77.9% of HAP/VAP, in this setting Pseudomonas aeruginosa accounted for 17.6% of infections while Klebsiella spp. accounted for 22.1% of infections. Colonization with resistant bacteria (HR 2.21, 95% CI 1.12-4.35) was associated with increased risk of infections while perioperative antimicrobial prophylaxis (PAP) covering Gram-negative bacteria at transplant (HR 0.45, 95% CI 0.23-0.90, p = 0.023) was a protective factor.Conclusion: This study shows that Gram-negative infections represent the major challenge for HT patients during ICU stay and shows some evidence in support of the PAP covering Gram-negative infections at transplant.","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70031"},"PeriodicalIF":2.6000,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transplant Infectious Disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/tid.70031","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"IMMUNOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Infections occurring in the early post-heart transplant (HT) period heavily contribute to morbidity and mortality. Our goal is to evaluate the incidence of hospital-acquired pneumonia/ventilator-associated pneumonia (HAP/VAPs) and/or bloodstream infections (BSIs) after HT during the intensive care unit (ICU) stay and identify their associated risk factors in our tertiary hospital.

Methods: Observational prospective study including all adult patients who consecutively underwent HT from January 1, 2015 to August 31, 2023 at Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. HAP/VAPs and BSIs diagnosed during ICU were included in the analysis.

Results: A total of 106 patients were included, 38 of whom had at least one infectious episode (35.8%), for a total of 57 independent episodes and their incidence was 2.2 per 100 days (95% CI 1.7-2.8). Length of ICU stay was 8 days (IQR: 6-11) for patients without infectious events and 27 days (IQR 14-52) for those with infectious events (p < 0.001). Gram-negative bacteria were associated with 62.8% of BSIs (mainly Enterobacterales) and with 77.9% of HAP/VAP, in this setting Pseudomonas aeruginosa accounted for 17.6% of infections while Klebsiella spp. accounted for 22.1% of infections. Colonization with resistant bacteria (HR 2.21, 95% CI 1.12-4.35) was associated with increased risk of infections while perioperative antimicrobial prophylaxis (PAP) covering Gram-negative bacteria at transplant (HR 0.45, 95% CI 0.23-0.90, p = 0.023) was a protective factor.

Conclusion: This study shows that Gram-negative infections represent the major challenge for HT patients during ICU stay and shows some evidence in support of the PAP covering Gram-negative infections at transplant.

查看原文本刊更多论文

心脏移植术后重症监护期间细菌感染的挑战。

背景：心脏移植术后早期的感染是导致发病率和死亡率的重要因素。我们的目标是评估我们三级医院重症监护病房（ICU）住院期间HT后医院获得性肺炎/呼吸机相关肺炎（HAP/VAPs）和/或血液感染（bsi）的发生率，并确定其相关危险因素。方法：观察性前瞻性研究，纳入2015年1月1日至2023年8月31日在意大利帕维亚市圣马特奥市的fundazione IRCCS Policlinico接受HT治疗的所有成年患者。ICU期间诊断的HAP/VAPs和bsi纳入分析。结果：共纳入106例患者，其中38例至少有一次感染发作（35.8%），共57次独立发作，发生率为2.2 / 100天（95% CI 1.7-2.8）。无感染事件患者的ICU住院时间为8天（IQR: 6-11），有感染事件患者的ICU住院时间为27天（IQR: 14-52） (p结论：本研究表明，革兰氏阴性感染是HT患者在ICU住院期间的主要挑战，并显示了一些证据支持PAP覆盖移植时革兰氏阴性感染。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Transplant Infectious Disease 医学-传染病学

CiteScore

5.30

自引率

7.70%

发文量

210

审稿时长

4-8 weeks

期刊介绍： Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.