Shultes et al identified risk factors for early infection in patients undergoing heart transplant. These can help to identify a patient who may benefit from more aggressive management. The authors are from Belmont University (Nashville), Barnes-Jewish Hospital, St. Louis College of Pharmacy, Washington University, and Vanderbilt University.
Patient selection: heart transplant, age > 18 years of age
Outcome: early infection (within 30 days of transplant surgery)
Risk factors for early infection on multivariate logistic regression analysis:
(1) mechanical circulatory support (pretransplant LVAD or ECMO)
(2) continuous renal replacement therapy (CRRT)
Additional risk factors included:
(1) longer duration of mechanical ventilation and length of stay (LOS)
(2) history of drive line infection
(3) delayed chest closure
(4) resistance of organisms to antibiotic given for perioperative prophylaxis (mostly Gram negative bacteria or fungi)
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