Bacterial infections after pediatric heart transplantation: Epidemiology, risk factors and outcomes
Background Bacterial infections represent a major cause of morbidity and mortality in heart transplant recipients. However, data describing the epidemiology and outcomes of these infections in children are limited. Methods We analyzed the Pediatric Heart Transplant Study database of patients transpl...
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| Veröffentlicht in: | The Journal of heart and lung transplantation 2017-09, Vol.36 (9), p.996-1003 |
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| container_title | The Journal of heart and lung transplantation |
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| creator | Rostad, Christina A., MD Wehrheim, Karla, MD Kirklin, James K., MD Naftel, David, PhD Pruitt, Elizabeth, MSPH Hoffman, Timothy M., MD L’Ecuyer, Thomas, MD Berkowitz, Katie, MSN Mahle, William T., MD Scheel, Janet N., MD |
| description | Background Bacterial infections represent a major cause of morbidity and mortality in heart transplant recipients. However, data describing the epidemiology and outcomes of these infections in children are limited. Methods We analyzed the Pediatric Heart Transplant Study database of patients transplanted between 1993 and 2014 to determine the etiologies, risk factors and outcomes of children with bacterial infections post–heart transplantation. Results Of 4,458 primary transplants in the database, there were 4,815 infections that required hospitalization or intravenous therapy, 2,047 (42.51%) of which were bacterial. The risk of bacterial infection was highest in the first month post-transplant, and the bloodstream was the most common site (24.82%). In the early post-transplant period ( |
| doi_str_mv | 10.1016/j.healun.2017.05.009 |
| format | Article |
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However, data describing the epidemiology and outcomes of these infections in children are limited. Methods We analyzed the Pediatric Heart Transplant Study database of patients transplanted between 1993 and 2014 to determine the etiologies, risk factors and outcomes of children with bacterial infections post–heart transplantation. Results Of 4,458 primary transplants in the database, there were 4,815 infections that required hospitalization or intravenous therapy, 2,047 (42.51%) of which were bacterial. The risk of bacterial infection was highest in the first month post-transplant, and the bloodstream was the most common site (24.82%). In the early post-transplant period (<30 days post-transplant), coagulase-negative staphylococci were the most common pathogens (16.97%), followed by Enterobacter sp (11.99%) and Pseudomonas sp (11.62%). In the late post-transplant period, community-acquired pathogens Streptococcus pneumoniae (6.27%) and Haemophilus influenzae (2.82%) were also commonly identified. Patients’ characteristics independently associated with acquisition of bacterial infection included younger age ( p < 0.0001) and ventilator ( p < 0.0001) or extracorporeal membrane oxygenation ( p = 0.03) use at time of transplant. Overall mortality post-bacterial infection was 33.78%, and previous cardiac surgery ( p < 0.001) and multiple sites of infection ( p = 0.004) were independent predictors of death. Conclusions Bacteria were the most common causes of severe infections in pediatric heart transplant recipients and were associated with high mortality rates. The risk of acquiring a bacterial infection was highest in the first month post-transplant, and a large proportion of the infections were caused by multidrug-resistant pathogens.</description><identifier>ISSN: 1053-2498</identifier><identifier>EISSN: 1557-3117</identifier><identifier>DOI: 10.1016/j.healun.2017.05.009</identifier><identifier>PMID: 28583371</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Age Distribution ; bacterial ; Bacterial Infections - diagnosis ; Bacterial Infections - epidemiology ; Bacterial Infections - therapy ; Cause of Death ; Child ; Child, Preschool ; Cohort Studies ; Confidence Intervals ; Databases, Factual ; Female ; heart transplant ; Heart Transplantation - adverse effects ; Heart Transplantation - methods ; Heart Transplantation - mortality ; Humans ; Incidence ; infection ; Male ; Multivariate Analysis ; Outcome Assessment (Health Care) ; pediatric ; Postoperative Complications - epidemiology ; Postoperative Complications - microbiology ; Postoperative Complications - physiopathology ; Proportional Hazards Models ; Retrospective Studies ; Severity of Illness Index ; Sex Distribution ; Surgery ; Survival Analysis ; United States - epidemiology</subject><ispartof>The Journal of heart and lung transplantation, 2017-09, Vol.36 (9), p.996-1003</ispartof><rights>International Society for the Heart and Lung Transplantation</rights><rights>2017 International Society for the Heart and Lung Transplantation</rights><rights>Copyright © 2017 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c417t-428951fe7b9299403013fa1eba511a0e4ba35a0ca2df3d21dffa2bb5a05f05533</citedby><cites>FETCH-LOGICAL-c417t-428951fe7b9299403013fa1eba511a0e4ba35a0ca2df3d21dffa2bb5a05f05533</cites><orcidid>0000-0002-1744-333X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1053249817317904$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28583371$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rostad, Christina A., MD</creatorcontrib><creatorcontrib>Wehrheim, Karla, MD</creatorcontrib><creatorcontrib>Kirklin, James K., MD</creatorcontrib><creatorcontrib>Naftel, David, PhD</creatorcontrib><creatorcontrib>Pruitt, Elizabeth, MSPH</creatorcontrib><creatorcontrib>Hoffman, Timothy M., MD</creatorcontrib><creatorcontrib>L’Ecuyer, Thomas, MD</creatorcontrib><creatorcontrib>Berkowitz, Katie, MSN</creatorcontrib><creatorcontrib>Mahle, William T., MD</creatorcontrib><creatorcontrib>Scheel, Janet N., MD</creatorcontrib><title>Bacterial infections after pediatric heart transplantation: Epidemiology, risk factors and outcomes</title><title>The Journal of heart and lung transplantation</title><addtitle>J Heart Lung Transplant</addtitle><description>Background Bacterial infections represent a major cause of morbidity and mortality in heart transplant recipients. However, data describing the epidemiology and outcomes of these infections in children are limited. Methods We analyzed the Pediatric Heart Transplant Study database of patients transplanted between 1993 and 2014 to determine the etiologies, risk factors and outcomes of children with bacterial infections post–heart transplantation. Results Of 4,458 primary transplants in the database, there were 4,815 infections that required hospitalization or intravenous therapy, 2,047 (42.51%) of which were bacterial. The risk of bacterial infection was highest in the first month post-transplant, and the bloodstream was the most common site (24.82%). In the early post-transplant period (<30 days post-transplant), coagulase-negative staphylococci were the most common pathogens (16.97%), followed by Enterobacter sp (11.99%) and Pseudomonas sp (11.62%). In the late post-transplant period, community-acquired pathogens Streptococcus pneumoniae (6.27%) and Haemophilus influenzae (2.82%) were also commonly identified. Patients’ characteristics independently associated with acquisition of bacterial infection included younger age ( p < 0.0001) and ventilator ( p < 0.0001) or extracorporeal membrane oxygenation ( p = 0.03) use at time of transplant. Overall mortality post-bacterial infection was 33.78%, and previous cardiac surgery ( p < 0.001) and multiple sites of infection ( p = 0.004) were independent predictors of death. Conclusions Bacteria were the most common causes of severe infections in pediatric heart transplant recipients and were associated with high mortality rates. The risk of acquiring a bacterial infection was highest in the first month post-transplant, and a large proportion of the infections were caused by multidrug-resistant pathogens.</description><subject>Adolescent</subject><subject>Age Distribution</subject><subject>bacterial</subject><subject>Bacterial Infections - diagnosis</subject><subject>Bacterial Infections - epidemiology</subject><subject>Bacterial Infections - therapy</subject><subject>Cause of Death</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cohort Studies</subject><subject>Confidence Intervals</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>heart transplant</subject><subject>Heart Transplantation - adverse effects</subject><subject>Heart Transplantation - methods</subject><subject>Heart Transplantation - mortality</subject><subject>Humans</subject><subject>Incidence</subject><subject>infection</subject><subject>Male</subject><subject>Multivariate Analysis</subject><subject>Outcome Assessment (Health Care)</subject><subject>pediatric</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - microbiology</subject><subject>Postoperative Complications - physiopathology</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Severity of Illness Index</subject><subject>Sex Distribution</subject><subject>Surgery</subject><subject>Survival Analysis</subject><subject>United States - epidemiology</subject><issn>1053-2498</issn><issn>1557-3117</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUFv1DAQhS0EoqXwDxDykQMJM3a8WXNAKlULSJU4AGfLccbgbRIHO0Haf4-jLT1w4TSj0Zv37G8Ye4lQI-Du7aH-SXZYp1oAtjWoGkA_YueoVFtJxPZx6UHJSjR6f8ae5XwAACGVeMrOxF7tpWzxnLkP1i2Ugh14mDy5JcQpc-vLjM_UB7uk4HhJSgtfkp3yPNhpsZvsHb-eQ09jiEP8cXzDU8h33Be7mIrD1PO4Li6OlJ-zJ94OmV7c1wv2_eb629Wn6vbLx89Xl7eVa7BdqkbstUJPbaeF1g1IQOktUmcVogVqOiuVBWdF72UvsPfeiq4rI-VBKSkv2OuT75zir5XyYsaQHQ3lxRTXbFDDrmlB612RNiepSzHnRN7MKYw2HQ2C2fCagznhNRteA8oUvGXt1X3C2o3UPyz95VkE708CKv_8HSiZ7AJNrpBMBa7pY_hfwr8GbghTcHa4oyPlQ1zTVBgaNFkYMF-3E28XxlZiq6GRfwCtAKQO</recordid><startdate>20170901</startdate><enddate>20170901</enddate><creator>Rostad, Christina A., MD</creator><creator>Wehrheim, Karla, MD</creator><creator>Kirklin, James K., MD</creator><creator>Naftel, David, PhD</creator><creator>Pruitt, Elizabeth, MSPH</creator><creator>Hoffman, Timothy M., MD</creator><creator>L’Ecuyer, Thomas, MD</creator><creator>Berkowitz, Katie, MSN</creator><creator>Mahle, William T., MD</creator><creator>Scheel, Janet N., MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1744-333X</orcidid></search><sort><creationdate>20170901</creationdate><title>Bacterial infections after pediatric heart transplantation: Epidemiology, risk factors and outcomes</title><author>Rostad, Christina A., MD ; Wehrheim, Karla, MD ; Kirklin, James K., MD ; Naftel, David, PhD ; Pruitt, Elizabeth, MSPH ; Hoffman, Timothy M., MD ; L’Ecuyer, Thomas, MD ; Berkowitz, Katie, MSN ; Mahle, William T., MD ; Scheel, Janet N., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c417t-428951fe7b9299403013fa1eba511a0e4ba35a0ca2df3d21dffa2bb5a05f05533</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adolescent</topic><topic>Age Distribution</topic><topic>bacterial</topic><topic>Bacterial Infections - diagnosis</topic><topic>Bacterial Infections - epidemiology</topic><topic>Bacterial Infections - therapy</topic><topic>Cause of Death</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cohort Studies</topic><topic>Confidence Intervals</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>heart transplant</topic><topic>Heart Transplantation - adverse effects</topic><topic>Heart Transplantation - methods</topic><topic>Heart Transplantation - mortality</topic><topic>Humans</topic><topic>Incidence</topic><topic>infection</topic><topic>Male</topic><topic>Multivariate Analysis</topic><topic>Outcome Assessment (Health Care)</topic><topic>pediatric</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - microbiology</topic><topic>Postoperative Complications - physiopathology</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Severity of Illness Index</topic><topic>Sex Distribution</topic><topic>Surgery</topic><topic>Survival Analysis</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rostad, Christina A., MD</creatorcontrib><creatorcontrib>Wehrheim, Karla, MD</creatorcontrib><creatorcontrib>Kirklin, James K., MD</creatorcontrib><creatorcontrib>Naftel, David, PhD</creatorcontrib><creatorcontrib>Pruitt, Elizabeth, MSPH</creatorcontrib><creatorcontrib>Hoffman, Timothy M., MD</creatorcontrib><creatorcontrib>L’Ecuyer, Thomas, MD</creatorcontrib><creatorcontrib>Berkowitz, Katie, MSN</creatorcontrib><creatorcontrib>Mahle, William T., MD</creatorcontrib><creatorcontrib>Scheel, Janet N., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of heart and lung transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rostad, Christina A., MD</au><au>Wehrheim, Karla, MD</au><au>Kirklin, James K., MD</au><au>Naftel, David, PhD</au><au>Pruitt, Elizabeth, MSPH</au><au>Hoffman, Timothy M., MD</au><au>L’Ecuyer, Thomas, MD</au><au>Berkowitz, Katie, MSN</au><au>Mahle, William T., MD</au><au>Scheel, Janet N., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Bacterial infections after pediatric heart transplantation: Epidemiology, risk factors and outcomes</atitle><jtitle>The Journal of heart and lung transplantation</jtitle><addtitle>J Heart Lung Transplant</addtitle><date>2017-09-01</date><risdate>2017</risdate><volume>36</volume><issue>9</issue><spage>996</spage><epage>1003</epage><pages>996-1003</pages><issn>1053-2498</issn><eissn>1557-3117</eissn><abstract>Background Bacterial infections represent a major cause of morbidity and mortality in heart transplant recipients. However, data describing the epidemiology and outcomes of these infections in children are limited. Methods We analyzed the Pediatric Heart Transplant Study database of patients transplanted between 1993 and 2014 to determine the etiologies, risk factors and outcomes of children with bacterial infections post–heart transplantation. Results Of 4,458 primary transplants in the database, there were 4,815 infections that required hospitalization or intravenous therapy, 2,047 (42.51%) of which were bacterial. The risk of bacterial infection was highest in the first month post-transplant, and the bloodstream was the most common site (24.82%). In the early post-transplant period (<30 days post-transplant), coagulase-negative staphylococci were the most common pathogens (16.97%), followed by Enterobacter sp (11.99%) and Pseudomonas sp (11.62%). In the late post-transplant period, community-acquired pathogens Streptococcus pneumoniae (6.27%) and Haemophilus influenzae (2.82%) were also commonly identified. Patients’ characteristics independently associated with acquisition of bacterial infection included younger age ( p < 0.0001) and ventilator ( p < 0.0001) or extracorporeal membrane oxygenation ( p = 0.03) use at time of transplant. Overall mortality post-bacterial infection was 33.78%, and previous cardiac surgery ( p < 0.001) and multiple sites of infection ( p = 0.004) were independent predictors of death. Conclusions Bacteria were the most common causes of severe infections in pediatric heart transplant recipients and were associated with high mortality rates. The risk of acquiring a bacterial infection was highest in the first month post-transplant, and a large proportion of the infections were caused by multidrug-resistant pathogens.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28583371</pmid><doi>10.1016/j.healun.2017.05.009</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-1744-333X</orcidid></addata></record> |
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| subjects | Adolescent Age Distribution bacterial Bacterial Infections - diagnosis Bacterial Infections - epidemiology Bacterial Infections - therapy Cause of Death Child Child, Preschool Cohort Studies Confidence Intervals Databases, Factual Female heart transplant Heart Transplantation - adverse effects Heart Transplantation - methods Heart Transplantation - mortality Humans Incidence infection Male Multivariate Analysis Outcome Assessment (Health Care) pediatric Postoperative Complications - epidemiology Postoperative Complications - microbiology Postoperative Complications - physiopathology Proportional Hazards Models Retrospective Studies Severity of Illness Index Sex Distribution Surgery Survival Analysis United States - epidemiology |
| title | Bacterial infections after pediatric heart transplantation: Epidemiology, risk factors and outcomes |
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