Significance of positive cultures from donor left atrium and postpreservation fluid in heart transplantation

The significance of positive perioperative cultures routinely obtained from the donor left atrium and postpreservation fluid during heart transplantation is unknown. A retrospective chart review of 128 heart transplant recipients was done. A total of 106 of 128 patients had left atrial and/or postpreservation fluid cultures performed; 61 (57.5%) of them were positive. Forty-one positive left atrial or postpreservation cultures grew indolent organisms and 20 grew virulent organisms. Six donors had positive blood cultures, and five of the six did not have left atrial or postpreservation fluid cultures positive for the same organism. Seven recipients had positive blood cultures with organisms different from their corresponding left atrial or postpreservation fluid cultures. Three patients had sternal wound infections with organisms different from their donors' left atrial or postpreservation fluid cultures. Seven patients received additional antibiotics after heart transplantation specifically directed at a positive left atrial or postpreservation fluid culture for 5 to 7 days; none of them developed infection with these organisms. We found no evidence that positive donor left atrium or postpreservation fluid cultures increase the recipients' risk of infection. Nevertheless, we cannot refute that the small group of patients who received additional antibiotics might have developed an infection if they had not been treated. We recommend that the left atrial and postpreservation fluid cultures growing indolent organisms be discounted. However, if they grow more virulent organisms, consideration could be given to a brief course of specific therapy while awaiting recipient cultures.