Hostname: page-component-76fb5796d-vfjqv Total loading time: 0 Render date: 2024-04-26T20:46:49.786Z Has data issue: false hasContentIssue false
  • English
  • Français

An Outbreak of Mediastinitis Among Heart Transplant Recipients Apparently Related to a Change in the United Network for Organ Sharing Guidelines

Published online by Cambridge University Press:  02 January 2015

Rafik Samuel ,
Peter Axelrod ,
Keith St. John ,
Thomas Fekete ,
Sharon Alexander ,
James McCarthy ,
Allan Truant ,
Barbara Todd ,
Satoshi Furukawa  and
Howard Eisen
...Show all authors
Rafik Samuel*
Affiliation:
Section of Infectious Diseases, Temple University Hospital, Philadelphia, Pennsylvania
Peter Axelrod
Affiliation:
Section of Infectious Diseases, Temple University Hospital, Philadelphia, Pennsylvania Department of Infection Control, Temple University Hospital, Philadelphia, Pennsylvania
Keith St. John
Affiliation:
Department of Infection Control, Temple University Hospital, Philadelphia, Pennsylvania
Thomas Fekete
Affiliation:
Section of Infectious Diseases, Temple University Hospital, Philadelphia, Pennsylvania
Sharon Alexander
Affiliation:
Department of Infection Control, Temple University Hospital, Philadelphia, Pennsylvania
James McCarthy
Affiliation:
Section of Cardiothoracic Surgery, Temple University Hospital, Philadelphia, Pennsylvania
Allan Truant
Affiliation:
Department of Microbiology, Temple University Hospital, Philadelphia, Pennsylvania
Barbara Todd
Affiliation:
Section of Cardiothoracic Surgery, Temple University Hospital, Philadelphia, Pennsylvania
Satoshi Furukawa
Affiliation:
Section of Cardiothoracic Surgery, Temple University Hospital, Philadelphia, Pennsylvania
Howard Eisen
Affiliation:
Section of Cardiology, Temple University Hospital, Philadelphia, Pennsylvania
William Spotnitz
Affiliation:
Section of Cardiothoracic Surgery, Temple University Hospital, Philadelphia, Pennsylvania
*
Section of Infectious Diseases, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To describe an outbreak of mediastinitis in heart transplant recipients.

Design:

Retrospective and contemporaneous cohort study.

Setting:

Urban tertiary-care university hospital with a large cardiac transplantation program.

Patients:

Heart transplant recipients.

Interventions:

Modifications of donor harvest technique; procedures aimed at decreasing skin and mucosal bacterial colonization; strict aseptic technique in the intensive care unit; and aggressive policing of established infection control practices.

Results:

In April 1999, mediastinitis rates among heart transplant recipients increased abruptly from a baseline of 6 cases per 100 procedures to sequential quarterly rates of 22, 31, and 50 cases per 100 procedures, whereas infection rates in other cardiac operations were unchanged. Bacteria causing these infections were multidrug-resistant "nosocomial" organisms. The epidemic occurred 2 months after a change in the United Network for Organ Sharing organ allocation algorithm. This change resulted in an increase in the duration of preoperative hospitalization from a median of 52 to 79 days (P = .008) and may have promoted prolonged hospitalization of patients with high illness severity. Aggressive multidisciplinary interventions were temporally associated with a return to preoperative mediastinitis rates without changing length of hospitalization prior to transplantation.

Conclusions:

Changes in organ allocation for transplant that prolong waiting time in the hospital and alter illness acuity may lead to increased rates of postoperative infection. Measures to limit bacterial colonization may be a helpful countervailing strategy.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 7 , July 2002 , pp. 377 - 381
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Kutsal, A, Ibrisim, E, Catav, Z, et al. Mediastinitis after open heart surgery. J Cardiovasc Surg 1991;32:38–41.Google Scholar
2.Sarr, M, Gott, V, Townsend, T. Mediastinal infection after cardiac surgery. Ann Thorac Surg 1984;38:415–423.Google Scholar
3.Borger, M, Rao, V, Weisel, R, et al. Deep sternal wound infection: risk factors and outcomes. Ann Thorac Surg 1998;65:1050–1056.CrossRefGoogle ScholarPubMed
4.Farinas, MC, Peralta, FG, Bernal, JM, et al. Suppurative mediastinitis after open-heart surgery: a case-control study covering a seven-year period in Santander, Spain. Clin Infect Dis 1995;20:272–279.Google Scholar
5.Grossi, EA, Culliford, AT, Krieger, KH, et al. A survey of 77 major infectious complications of median sternotomy: a review of 7,949 consecutive operative procedures. Ann Thorac Surg 1985;40:214–223.Google Scholar
6.Milano, C, Kesler, K, Archibald, N, et al. Mediastinitis after coronary artery bypass graft surgery. Circulation 1995;92:2245–2251.Google Scholar
7.Culliford, AT, Cunningham, JN, Zeff, RH, et al. Sternal and costochondral infections following open-heart surgery: a review of 2,594 cases. J Thorac Cardiovasc Surg 1976;72:714–726.Google Scholar
8.Ottino, G, De Paulis, R, Pansini, S, et al. Major sternal wound infection after open-heart surgery: a multivariate analysis of risk factors in 2,579 consecutive operative procedures. Ann Thorac Surg 1987;44:173–179.Google Scholar
9.Demmy, TL, Park, SB, Liebler, GA, et al. Recent experience with major sternal wound complications. Ann Thorac Surg 1990;49:458–462.Google Scholar
10.Shuhaiber, H, Chugh, T, Portoian-Shuhaiber, S, Ghosh, D. Wound infection in cardiac surgery. J Cardiovasc Surg 1987;28:139–142.Google Scholar
11.The Parisian Mediastinitis Study Group. Risk factors for deep sternal wound infection after sternotomy: a prospective, multicenter study. J Thorac Cardiovasc Surg 1996;111:1200–1207.Google Scholar
12.Newman, LS, Szczukowski, LC, Bain, RP, Perlino, CA. Suppurative mediastinitis after open heart surgery. Chest 1988;94:546–553.Google Scholar
13.Munoz, P, Menasalvas, A, Bernaldo de Quiros, JCL, et al. Postsurgical mediastinitis: a case-control study. Clin Infect Dis 1997;25:1060–1064.Google Scholar
14.Karwande, SV, Renlund, DG, Olsen, SL, et al. Mediastinitis in heart transplantation. Ann Thorac Surg 1992;54:1039–1045.CrossRefGoogle ScholarPubMed
15.Baldwin, RT, Radovancevic, B, Sweeney, MS, et al. Bacterial mediastinitis after heart transplantation. J Heart Lung Transplant 1992;11:545–549.Google Scholar
16.Trento, A, Dummer, GS, Hardesty, RL, et al. Mediastinitis following heart transplantation; incidence, treatment, and results. Heart Transplant 1984;3:336–340.Google Scholar
17.Boyce, JM, Potter-Boyne, G, Opal, SM, et al. A common-source outbreak of Staphylococcus epidermidis infections among patients undergoing cardiac surgery. J Infect Dis 1990;161:493–499.CrossRefGoogle ScholarPubMed
18.Mossad, SB, Serkey, JM, Longworth, DL, et al. Coagulase-negative staphylococcal sternal wound infections after open heart operations. Ann Thorac Surg 1997;63:395–401.Google Scholar
19.Sielaff, TD, Everett, JE, Shumway, SJ, et al. Mycoplasma hominis infections occurring in cardiovascular surgical patients. Ann Thorac Surg 1996;61:99–103.Google Scholar
20.Palmer, DL, Kuritsky, JN, Lapham, SC, et al. Enterobacter mediastinitis following cardiac surgery. Infect Control 1985;6:115–119.CrossRefGoogle ScholarPubMed
21.Ehrenkranz, NJ, Pfaff, SJ. Mediastinitis complicating cardiac operations: evidence of postoperative causation. Rev Infect Dis 1991;13:803–814.Google Scholar
22.Weingarten, CM, Rybak, MJ, Jahns, BE, et al. Evaluation Acinetobacter baumannii infection and colonization, and antimicrobial patterns in an urban teaching hospital. Pharmacotherapy 1999;19:1080–1085.Google Scholar
23.Papanicalaou, GA, Meyers, BR, Meyers, J, et al. Nosocomial infections with vancomycin resistant Enterococcus faecium in liver transplant recipients: risk factors for acquisition and mortality. Clin Infect Dis 1996; 23:760–766.Google Scholar
24.Goldmann, DA, LeClair, J, Macone, A. Bacterial colonization of neonates admitted to an intensive care environment. J Pediatr 1978;93:288–293.CrossRefGoogle Scholar
25.Brown, DC, Conzemius, MG, Shofer, F, Swann, H. Epidemiologic evaluation of postoperative wound infections in dogs and cats. J Am Vet Med Assoc 1997;210:1302–1306.Google Scholar
26.Brachman, PS. Epidemiology of nosocomial infections. In: Bennet, JV, Brachman, PS, eds. Hospital Infections, 4th ed. Philadelphia: Lippincott Raven; 1998:13.Google Scholar