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Infective endocarditis in solid organ transplant recipients

D L Paterson1, E A Dominguez, F Y Chang

  • 1Disease Section, Veterans Affairs Medical Center, Pittsburgh, Pennsylvania 15240, USA.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|April 3, 1998
PubMed
Summary

Infective endocarditis in transplant recipients differs from the general population, with Aspergillus and Staphylococcus aureus being common causes. This serious complication of hospital-acquired infections has a high mortality rate.

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Area of Science:

  • Infectious Diseases
  • Transplantation Medicine
  • Cardiology

Background:

  • Infective endocarditis (IE) is a serious complication.
  • Solid organ transplant recipients may have unique risk factors and causative organisms for IE.
  • Understanding IE spectrum in this population is crucial for timely diagnosis and management.

Purpose of the Study:

  • To characterize the spectrum of organisms, risk factors, and outcomes of infective endocarditis in solid organ transplant recipients.
  • To compare IE in transplant recipients to the general population.
  • To highlight endocarditis as an underappreciated sequela of hospital-acquired infections in this vulnerable group.

Main Methods:

  • Retrospective case review of 14 transplant recipients with IE at reporting institutions.

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  • Inclusion of 32 previously reported cases in solid organ transplant recipients.
  • Analysis of causative organisms, timing of infection, predisposing factors, and mortality.

    • Main Results:

    • Organism spectrum differed significantly: Aspergillus and Staphylococcus aureus (50%) were common, unlike viridans streptococci (4%).
    • Fungal infections predominated early post-transplant (<30 days), while bacterial infections were more common later.
    • 80% lacked underlying valvular disease; 74% were linked to hospital-acquired infections (e.g., central lines, wound infections).
    • Mortality was high at 57%, with 58% of deaths not suspected during life.

    Conclusions:

    • Infective endocarditis in transplant recipients presents with a distinct microbial profile compared to the general population.
    • Hospital-acquired infections are significant risk factors for IE in this cohort.
    • High mortality and underdiagnosis underscore the need for increased awareness and vigilance for endocarditis in transplant patients.