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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
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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

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