Manuel Martínez-Sellés1, Maricela Valerio-Minero2, María Carmen Fariñas3, Hugo Rodríguez-Abella4, María Luisa Rodríguez5, Aristides de Alarcón6, Encarnación Gutiérrez-Carretero7, Manuel Cobo-Belaustegui8, Miguel Ángel Goenaga9, Asunción Moreno-Camacho10, Fernando Domínguez11, Laura García-Pérez12, Laura Domínguez-Pérez13, Patricia Muñoz14. 1. Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV. Universidad Europea. Universidad Complutense. Madrid, Spain. Electronic address: mmselles@secardiologia.es. 2. Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid. Instituto de Investigación Sanitaria Gregorio Marañón. Madrid, Spain. 3. Infectious Diseases Unit. Hospital Universitario Marqués de Valdecilla. University of Cantabria, Santander, Spain. 4. Servicio de Cirugía Cardiaca, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 5. Servicio de Nefrología. Hospital General Universitario Gregorio Marañón, Madrid, Spain. 6. Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine Infectious Diseases Research Group Institute of Biomedicine of Seville (IBiS) University of Seville/CSIC/University Hospital Virgen del Rocío Seville, Spain. 7. Cardiac Surgery Service CIBERCV Institute of Biomedicine of Seville (IBiS) University of Seville/CSIC/University Hospital Virgen del Rocío Seville, Spain. 8. Servicio de Cardiología. Hospital Universitario Marqués de Valdecilla. Santander. Spain. 9. Servicio de Enfermedades Infecciosas. Hospital Universitario Donosti. San Sebastián. Spain. 10. Infectious Diseases Service. Hospital Clinic - IDIBAPS. University of Barcelona. Barcelona. Spain. 11. Servicio de Cardiología. Hospital Universitario Puerta de Hierro. Majadahonda. Madrid, Spain. 12. Servicio de Cardiología AGC del Corazón. Hospital Central de Asturias. Oviedo, Spain. 13. Unidad clínica y unidad de cuidados críticos cardiológicos. Hospital Universitario Doce de Octubre. Madrid, Spain. 14. Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid. Instituto de Investigación Sanitaria Gregorio Marañón. CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058). Facultad de Medicina, Universidad Complutense de Madrid.
Abstract
BACKGROUND: Solid organ transplantation (SOT) implies immunosuppression and frequent health care contact. Our aim was to compare the characteristics of patients with infective endocarditis (IE) and SOT against those without SOT. METHODS: We used data from the Spanish Collaboration on Endocarditis during the period 2008-2018. RESULTS: We identified 4794 cases of IE, 85 (1.8%) in SOT (56 kidney, 18 liver, 8 heart, 3 lung). Thirteen patients with other transplantation types (bone marrow, hematopoietic precursors, and cornea) were excluded from the analysis. Compared with patients without SOT, patients with SOT had lower median age (61 vs. 69 years, p<0.001), more comorbidities (mean age-adjusted Charlson index 5.7±2.9 vs. 4.9±2.9, p=0.004), a lower prevalence of native valvular heart disease (29.4 vs. 45.4%, p=0.003), more in-hospital and healthcare-related IE (70.5% vs. 36.3%, p<0.001) and staphylococcal etiology (57.7% vs. 39.7%, p=0.001). Patients with SOT had more frequent kidney function worsening (47.1% vs. 34.6%, p=0.02), septic shock (25.9% vs. 12.1 %, p<0.001), sepsis (27.1% vs. 17.2%, p=0.02), and less surgery indication (54.1% vs 66.3%, p=0.02) and surgery (32.9% vs. 46.3%, p=0.01) than patients without SOT. There were no significant differences in mortality: inhospital (30.6% SOT vs. 25.6% without SOT, p=0.31), 1-year (38.8% SOT vs. 31.9% without SOT, p=0.18). CONCLUSIONS: Most IE in SOT recipients are nosocomial and over 70% are health care-related. Half have previously normal heart valves and almost 60% are due to Staphylococcus spp. infections. Mortality seems to be similar to non-SOT counterparts.
BACKGROUND: Solid organ transplantation (SOT) implies immunosuppression and frequent health care contact. Our aim was to compare the characteristics of patients with infective endocarditis (IE) and SOT against those without SOT. METHODS: We used data from the Spanish Collaboration on Endocarditis during the period 2008-2018. RESULTS: We identified 4794 cases of IE, 85 (1.8%) in SOT (56 kidney, 18 liver, 8 heart, 3 lung). Thirteen patients with other transplantation types (bone marrow, hematopoietic precursors, and cornea) were excluded from the analysis. Compared with patients without SOT, patients with SOT had lower median age (61 vs. 69 years, p<0.001), more comorbidities (mean age-adjusted Charlson index 5.7±2.9 vs. 4.9±2.9, p=0.004), a lower prevalence of native valvular heart disease (29.4 vs. 45.4%, p=0.003), more in-hospital and healthcare-related IE (70.5% vs. 36.3%, p<0.001) and staphylococcal etiology (57.7% vs. 39.7%, p=0.001). Patients with SOT had more frequent kidney function worsening (47.1% vs. 34.6%, p=0.02), septic shock (25.9% vs. 12.1 %, p<0.001), sepsis (27.1% vs. 17.2%, p=0.02), and less surgery indication (54.1% vs 66.3%, p=0.02) and surgery (32.9% vs. 46.3%, p=0.01) than patients without SOT. There were no significant differences in mortality: inhospital (30.6% SOT vs. 25.6% without SOT, p=0.31), 1-year (38.8% SOT vs. 31.9% without SOT, p=0.18). CONCLUSIONS: Most IE in SOT recipients are nosocomial and over 70% are health care-related. Half have previously normal heart valves and almost 60% are due to Staphylococcus spp. infections. Mortality seems to be similar to non-SOT counterparts.