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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.
Abstract:
Infective endocarditis, defined as pathologically or clinically definite by the Duke criteria, was observed in 14 transplant recipients at our institutions. In addition, we reviewed 32 previously reported cases in solid organ transplant recipients. The spectrum of organisms causing infective endocarditis was clearly different in transplant recipients than in the general population; 50% of the infections were due to Aspergillus fumigatus or Staphylococcus aureus, but only 4% were due to viridans streptococci. Fungal infections predominated early (accounting for six of 10 cases of endocarditis within 30 days of transplantation), while bacterial infections caused most cases (80%) after this time. In 80% (37) of the 46 cases in transplant recipients, there was no underlying valvular disease. Seventy-four percent (34) of the 46 cases were associated with previous hospital-acquired infection, notably venous access device and wound infections. Three patients with S. aureus endocarditis had had an episode of S. aureus bacteremia > 3 weeks prior to the diagnosis of endocarditis and had received treatment for the initial bacteremia of < 14 days' duration. The overall mortality rate was 57% (26 of 46 patients died), with 58% (15) of the 26 fatal cases not being suspected during life. Endocarditis is an underappreciated sequela of hospital-acquired infection in transplant recipients.
Insights
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.
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.
- 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.