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Updated: Jan 3, 2026
Murine Heterotopic Heart Transplant Technique
Published on: July 8, 2014
Infections due to multidrug-resistant organisms following heart transplantation: Epidemiology, microbiology, and
Pinki J Bhatt1, Mohsin Ali2,3, Meenakshi Rana4
1Department of Medicine, Division of Infectious Diseases, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Background:
Infections secondary to multidrug-resistant organisms (MDRO) have emerged as a growing problem in solid organ transplantation (SOT). Most of the published data on MDRO infections in SOT pertains to abdominal organ transplantation and data specific to heart transplantation (HT) are limited.
Methods:
This is a retrospective review of HT recipients at our institution from 2011 to 2016; with the aim to investigate the epidemiology, microbiologic spectrum, and outcomes in patients with post-HT MDRO infections, classified as multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) using standardized definitions.
Results:
Of the 149 HT recipients, 82 episodes of bacterial infection were seen in 46 patients (31%) in the year following HT. Thirty (37%) were due to MDR pathogens and 13 (16%) were XDR. The most common gram-negative MDR pathogens were extended-spectrum beta-lactamase (ESBL) Escherichia coli and Klebsiella pneumoniae; while XDR pathogens were most commonly Pseudomonas aeruginosa followed by carbapenem-resistant Klebsiella pneumoniae. Majority of infection episodes were bloodstream (54, 66%) followed by pulmonary infection (20, 24%). Within a year after transplant, HT recipients with any bacterial infection had significantly higher mortality versus those without infection; and XDR infections were associated with a 26-fold greater hazard of death on average compared to those without infection (adjusted HR, 26.1; 95% CI, 6.4-107.0; P < .001). There were no PDR infections.
Conclusion:
Bacterial infections were a significant predictor of 1-year post-HT mortality, which was highest among those with XDR infections. This study highlights the burden of MDRO infections in HT recipients and identifies an area of future research.
Insights
Multidrug-resistant organism (MDRO) infections significantly increase mortality in heart transplant (HT) recipients. Extensively drug-resistant (XDR) infections pose the greatest risk, highlighting the need for targeted prevention and treatment strategies.
Area of Science:
- Infectious Diseases
- Transplantation Medicine
- Antimicrobial Resistance
Background:
- Multidrug-resistant organisms (MDRO) infections are a growing concern in solid organ transplantation (SOT).
- Limited data exists on MDRO infections specifically within heart transplantation (HT) compared to abdominal SOT.
Purpose of the Study:
- To investigate the epidemiology, microbiology, and outcomes of MDRO infections in heart transplant recipients.
- To classify infections as multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) using standardized definitions.
Main Methods:
- Retrospective review of heart transplant recipients from 2011 to 2016.
- Analysis of bacterial infection episodes, pathogen characteristics, and patient outcomes.
Main Results:
- 31% of 149 HT recipients experienced bacterial infections within one year post-transplant.
- 37% of infections were MDR and 16% were XDR; common pathogens included ESBL E. coli, K. pneumoniae, and Pseudomonas aeruginosa.
- XDR infections were associated with a 26-fold increased hazard of death (adjusted HR, 26.1; P < .001).
Conclusions:
- Bacterial infections, particularly XDR, are significant predictors of 1-year post-HT mortality.
- This study underscores the substantial burden of MDRO infections in HT recipients.
- Further research is warranted to address MDRO infections in this vulnerable population.
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