Although infection remains an important cause of morbidity and mortality among OTR, IE is a rare complication. Considerable mortality (up to 80%) and a substantial portion of cases of IE attributable to fungi (up to 28%) have been described in studies done in a previous era of transplantation. It is not known how the clinical features and outcomes of IE among OTR in the current era compare to this earlier time and to non-OTR.
We conducted a retrospective cohort study comparing patients with definitive IE by Duke criteria diagnosed at Cleveland Clinic between 2008–2014. Individuals were categorized as OTR or non-OTR. We performed 4:1 matching of non-OTR to OTR on age and microorganism using the nearest neighbor method. Data were collected by retrospective review of electronic medical records. The primary outcome was 30-day mortality.
We matched 14 OTR to 56 non-OTR. Overall, 77% were male; 76% were white. Transplanted organs included 8 kidney, 2 kidney/ pancreas, 3 lung, and 1 heart. Median time from transplantation to IE was 1,017 days (range, 66–4064). Among these 14 OTR, Enterococcus was the most common organism, causing 7 (50%) episodes. Others included coagulase-negative Staphylococcus species in 2 (14%) episodes, MSSA in 1 (7%), MRSA in 1 (7%), Streptococcus species in 1 (7%), Pseudomonas in 1 (7%), and Tropheryma whipplei in 1 (7%). One case of Enterococcus was a mixed infection with Candida species. 9 (64%) OTR had a prosthetic valve or cardiac device at the time of diagnosis compared to 30 (54%) non-OTR. There was no difference between groups in the median number of days of positive blood cultures (5 days in each group), the proportion undergoing surgical management (86% in each group), or the median number of days of antibiotics (47 for OTR vs. 53 for non-OTR). Extra-cardiac complications were more frequent in non-OTR compared to OTR (48% vs. 29%). 30-day mortality among OTR was 14% compared to no deaths within the first 30 days among the matched non-OTR (p=0.037).
Bacterial infection, particularly Enterococcus, accounted for the vast majority of episodes of IE among OTR in the current era at our institution. In this age- and microorganism-matched cohort, there were more extra-cardiac complications in non-OTR controls. Mortality was overall low but higher among OTR.
N. Shrestha, None
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