Post-operative Nosocomial Infections After Lung and Heart Transplantation Frauke Mattner, MD, a Stefan Fischer, MD, MSc, b Hartmut Weissbrodt, MD, a Iris F. Chaberny, MD, a Dorit Sohr, PhD, c Jens Gottlieb, MD, d Tobias Welte, MD, d Cornelia Henke-Gendo, MD, e Petra Gastmeier, MD, a and Martin Strueber, MD b Background: Thoracic transplant recipients appear to be at high risk for post-operative infections. Therefore, we investigated the incidence and risk factors of post-operative nosocomial infections (NIs) in lung and heart transplant recipients. Methods: From January 2002 to December 2003, a cohort of 208 consecutive thoracic transplant recipients (137 lung transplants [LTx], 51 heart transplants [HTx] and 20 combined transplants [CLTx]) were analyzed for post-operative infections and in-hospital mortality. NIs were determined according to CDC definitions. Uni- and multivariate risk factor analyses were performed. Results: Of the 157 NIs, 59 were pneumonia (37.6%), 34 primary sepsis (21.6%), 34 urinary tract (21.6%) and 30 surgical site (19.1%). Despite a total NI incidence of 75.5%, more importantly 56.3% of all patients remained free from any infection. CLTx patients had a higher risk of developing NIs (odds ratio [OR] 4.97; 95% confidence interval [CI] 1.74 to 15.34). Risk factors for NIs were volume reduction procedures in LTx (OR 2.6; 95% CI 1.13 to 6.30) and re-do Tx (OR 5.25; 95% CI 1.41 to 26.8). In LTx patients, pre-operative colonization with gram-negative rods was found to be a risk factor for post-transplant pneumonia (OR 3.7; 95% CI 1.19 to 11.37). Presence of NI (OR 2.53; 95% CI 1.07 to 6.25) was a risk factor for mortality, as was cystic fibrosis (OR 3.20; 95% CI 1.27 to 7.92) and ventilation prior to transplantation (OR 4.00; 95% CI 1.28 to 12.09). Conclusion: The mortality risk associated with NIs requires close infection surveillance for developing specific preventive anti-infection strategies. J Heart Lung Transplant 2007;26:241–9. Copyright © 2007 by the International Society for Heart and Lung Transplantation. Nosocomial infections (NIs) have been recognized as relevant factors for post-transplant morbidity and mor- tality in thoracic transplant recipients. 1,2 Factors inher- ent to thoracic transplantation, such as pre-existing cystic fibrosis, 3 cardiac function and immunosuppres- sion, may render thoracic transplant recipients espe- cially vulnerable to post-operative infectious complica- tions. Only a few reports on NIs in critically ill thoracic transplant recipients exist in the literature, limited by small sample sizes, the retrospective nature of the analyses, and the lack of clear definitions of the diagno- sis “pneumonia” in lung transplant recipients. 1,2,4 Fur- thermore, refinement in surgical techniques, anti-micro- bial prophylaxis and immunosuppression have most likely altered not only the frequency but also the overall spectrum of NIs. We conducted a prospective, patient-based surveil- lance study to assess the incidence, predisposing fac- tors and outcome of NIs in thoracic transplant recipi- ents using criteria from the Centers of Disease Control and Prevention (CDC) for the diagnosis of NIs and a modified definition of graft rejection from the Interna- tional Society for Heart and Lung Transplantation (ISHLT). 5 METHODS Between January 2002 and December 2003, 208 con- secutive patients underwent thoracic transplantation in the Thoracic Transplant Program, Hannover Medical School, Hannover, Germany. Routinely, all patients were admitted to the intensive care unit (ICU) after transplantation. Patients were prospectively followed throughout their post-operative hospital stay. From the a Institute of Medical Microbiology and Hospital Epidemiol- ogy and b Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover; c Department for Hospital Epidemiology and Environmental Medicine, Charité-Universitätsmedizin Berlin, Uni- versity of Berlin, Berlin; and d Division of Pulmonary Medicine and e Institute of Virology, Hannover Medical School, Hannover, Germany. Submitted January 16, 2006; revised September 26, 2006; accepted December 12, 2006. Reprint requests: Frauke Mattner, MD, Institute of Medical Micro- biology and Hospital Epidemiology, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany. Telephone: +49-511-532-8675. Fax: +49-511-532-8174. E-mail: mattner.frauke@ mh-hannover.de Copyright © 2007 by the International Society for Heart and Lung Transplantation. 1053-2498/07/$–see front matter. doi:10.1016/ j.healun.2006.12.009 241 TRANSPLANTATION INFECTION