Invasive surgical site infections after lung transplantation: contemporary risk factors and associated clinical outcomes

JHLT Open Pub Date : 2025-05-29 DOI:10.1016/j.jhlto.2025.100294

Manuela Carugati MD , Sana Arif MD , John Michael Reynolds MD , John Carroll Haney MD , Michael Edwards Yarrington MD, MM , Katherine Young MD , Deepika Kulkarni MD , Alzora Benjamin , Katina Walline , Jonathan Huggins MD, MSCE , Morgan Rosser PhD , Samantha Morrison PhD , Sarah Peskoe PhD , Brandi Ann Bottiger MD , Rachel Ann Miller MD , Barbara Dudley Alexander MD, MHS

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引用次数: 0

Abstract

Background

Invasive primary surgical site infections (IP-SSI) complicate lung transplant (LT) surgery. Identification of IP-SSI risk factors is critical to IP-SSI prevention.

Methods

This single-center retrospective cohort study of adult patients who underwent LT at Duke University over a 5-year period (2017–2021) aimed to identify IP-SSI risk factors and describe outcomes associated with IP-SSI diagnosis. IP-SSI risk factors were identified using a Least Absolute Shrinkage and Selection Operator procedure for logistic regression.

Results

IP-SSI occurred in 74/568 (13.0%) LT recipients. Restrictive lung disease, donor positive respiratory or blood cultures, operative time, post-transplant thoracic re-operation within 90 days of transplant, and ECMO by day 3 post-transplant were positively associated with IP-SSI. Obstructive lung disease, primary closure, and enhanced immunosuppression within 90 days of transplant were negatively associated with IP-SSI. Patients with IP-SSI were descriptively characterized by longer index transplant hospitalizations (92 vs. 22 days) and higher in-hospital (26.1% vs. 5.5%) and 1-year (20.3% vs. 12.1%) mortality rates than patients without IP-SSI. IP-SSI was significantly associated with 1-year mortality (HR 2.4, 1.3–4.3, p=0.003); however, the association was no longer significant (HR 1.4, 0.7–2.6, p=0.310) after adjusting for possible confounders.

Conclusions

Conservative surgical approaches, targeted antimicrobial prophylaxis, and increased surveillance for patients with IP-SSI risks may play a critical roleto limit IP-SSI in the LT population.

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肺移植术后侵袭性手术部位感染：当代危险因素及相关临床结果

背景：侵袭性原发手术部位感染（IP-SSI）使肺移植（LT）手术复杂化。识别IP-SSI风险因素对IP-SSI预防至关重要。方法：这项单中心回顾性队列研究对杜克大学5年（2017-2021年）期间接受肝移植的成年患者进行研究，旨在确定IP-SSI的危险因素，并描述与IP-SSI诊断相关的结果。使用最小绝对收缩和选择算子程序进行逻辑回归，确定IP-SSI危险因素。结果568例肝移植受者中有74例（13.0%）发生p - ssi。限制性肺疾病、供体呼吸或血液培养阳性、手术时间、移植后90天内胸腔再手术、移植后第3天ECMO与IP-SSI呈正相关。阻塞性肺疾病、初次闭合和移植90天内免疫抑制增强与IP-SSI呈负相关。IP-SSI患者的描述性特征是指数移植住院时间较长（92天对22天），住院率（26.1%对5.5%）和1年死亡率（20.3%对12.1%）高于非IP-SSI患者。IP-SSI与1年死亡率显著相关（HR 2.4, 1.3-4.3, p=0.003）；然而，在调整了可能的混杂因素后，这种关联不再显著（HR 1.4, 0.7-2.6, p=0.310）。结论保守的手术方法、有针对性的抗菌预防和加强对有IP-SSI风险的患者的监测可能在限制LT人群IP-SSI中发挥关键作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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JHLT Open

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