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. 2024 Jun 18;14(2):93567.
doi: 10.5500/wjt.v14.i2.93567.

Incidence, risk factors and clinical outcome of multidrug-resistant organisms after heart transplantation

Sophia Hatzianastasiou  1 , Paraskevas Vlachos  2 , Georgios Stravopodis  1 , Dimitrios Elaiopoulos  3 , Afentra Koukousli  1 , Josef Papaparaskevas  1 , Themistoklis Chamogeorgakis  2 , Kyrillos Papadopoulos  3 , Theodora Soulele  3 , Despoina Chilidou  2 , Kyriaki Kolovou  3 , Aggeliki Gkouziouta  2 , Michail Bonios  2 , Stamatios Adamopoulos  2 , Stavros Dimopoulos  4
Affiliations

Incidence, risk factors and clinical outcome of multidrug-resistant organisms after heart transplantation

Sophia Hatzianastasiou et al. World J Transplant. .

Abstract

Background: Transplant recipients commonly harbor multidrug-resistant organisms (MDROs), as a result of frequent hospital admissions and increased exposure to antimicrobials and invasive procedures.

Aim: 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.

Methods: 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.

Results: 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-χ 2: 7.34).

Conclusion: 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.

Keywords: Heart transplantation; Multi drug resistant organisms; Transplantation complications; Transplantation outcome.

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Conflict of interest statement

Conflict-of-interest statement: The authors have no financial relationships or other conflict of interest to disclose with regard to this study.

Figures

Figure 1
Figure 1
Multidrug-resistant organism carriage and bacteremia in heart transplantation patients (n = 98). Transplanted patients with multidrug-resistant organisms (MDROs): Acinetobacter baumannii was the most prevalent MDRO, followed by Pseudomonas aeruginosa and Klebsiella pneumoniae. MDRO acquisition: Half of the patients with Acinetobacter and a single patient with Pseudomonas were already colonized pre-transplantation, while most Pseudomonas strains and all Klebsiella strains were intensive care unit acquired. MDRO bacteremia was noted in about a third of Acinetobacter and Pseudomonas carriers. Four cases of MDRO bacteremia were donor-acquired (the donor was subsequently found to have been bacteremic at the time of organ procurement). All MDRO bacteremias were due to Gram-negative pathogens. MDRO: Multidrug-resistant organism.
Figure 2
Figure 2
Post-transplantation 1-year survival according to multidrug-resistant organism status. 1-year survival was 72% in heart transplant recipients with multidrug-resistant organism (MDRO) presence (MDRO+) vs 92% in MDRO-free (MDRO-) recipients (P < 0.01). MDRO: Multidrug-resistant organism.
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