1192. Infective Endocarditis (IE) among Organ Transplant Recipients (OTR) Compared to Non-OTR: Seven-Year Experience in a U.S Referral Center
Session: Poster Abstract Session: Transplant: Epidemiology of Infections in Transplant Patients and Other Patients with Impaired Immunity
Friday, October 9, 2015
Room: Poster Hall
Posters
  • IE in SOT poster 9-24-15.pdf (519.2 kB)
  • Background:

    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.

    Methods:

    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.

    Results:

    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).

    Conclusion:

    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.

    Sally Chuang, MD, Kyle Brizendine, MD and Nabin Shrestha, MD, MPH, FIDSA, FSHEA, Infectious Disease, Cleveland Clinic Foundation, Cleveland, OH

    Disclosures:

    S. Chuang, None

    K. Brizendine, None

    N. Shrestha, None

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