Infective endocarditis following orthotopic heart transplantation: 10 Cases and a review of the literature

S. Sherman-Weber, P. Axelrod, B. Suh, S. Rubin, D. Beltramo, J. Manacchio, S. Furukawa, T. Weber, H. Eisen, Rafik Samuel

Research output: Contribution to journalReview articlepeer-review

60 Scopus citations

Abstract

Background. Infective endocarditis is a known complication of cardiac transplantation. However, published information has been limited to case reports and small case series. Methods. Cardiac transplantation has been performed at Temple University Hospital since 1983. We identified transplant patients with ICD-9 codes for endocarditis or bacteremia. A diagnosis of endocarditis required fulfillment of the Duke criteria and presence of a vegetation. Clinical and microbiologic data were collected. Demographic and survival information were compared with heart transplant recipients without endocarditis. We reviewed all previously published cases using a MEDLINE search. Results. Ten of 659 heart transplant recipients had endocarditis (1.5%, 187 cases per 100,000 person years). Mitral and tricuspid valves were involved predominantly. No patient had aortic valve infection. Patients with tricuspid valve infection had a greater median number of endomyocardial biopsies (n = 23) than those with mitral valve infection (n = 9, P = 0.10). The major pathogens were Staphylococcus aureus (4 cases) and Aspergillus fumigatus (3 cases). Factors associated with S. aureus infection were new hemodialysis catheters, cellulitis, and a contaminated donor organ. All patients with A. fumigatus had antecedent cytomegalovirus viremia and disseminated fungal infection, including endophthalmitis. Endocarditis-related mortality was 80%. Median survival after transplant was 1.4 years in patients with endocarditis, compared with 9.3 years in other heart transplant recipients (P<0.001). Conclusions. Endocarditis is substantially more common in heart transplant recipients than in general populations. Frequent central venous catheter access and multiple endomyocardial biopsies appear to predispose to infection. Aspergillus is a common pathogen and endocarditis follows infection elsewhere. The prognosis of post-cardiac transplant endocarditis is poor.

Original languageEnglish (US)
Pages (from-to)165-170
Number of pages6
JournalTransplant Infectious Disease
Volume6
Issue number4
DOIs
StatePublished - Dec 1 2004

All Science Journal Classification (ASJC) codes

  • Infectious Diseases
  • Transplantation

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