Bacterial infections after pediatric heart transplantation: Epidemiology, risk factors and outcomes

J Heart Lung Transplant. 2017 Sep;36(9):996-1003. doi: 10.1016/j.healun.2017.05.009. Epub 2017 May 11.


Background: Bacterial infections represent a major cause of morbidity and mortality in heart transplant recipients. However, data describing the epidemiology and outcomes of these infections in children are limited.

Methods: We analyzed the Pediatric Heart Transplant Study database of patients transplanted between 1993 and 2014 to determine the etiologies, risk factors and outcomes of children with bacterial infections post-heart transplantation.

Results: Of 4,458 primary transplants in the database, there were 4,815 infections that required hospitalization or intravenous therapy, 2,047 (42.51%) of which were bacterial. The risk of bacterial infection was highest in the first month post-transplant, and the bloodstream was the most common site (24.82%). In the early post-transplant period (<30 days post-transplant), coagulase-negative staphylococci were the most common pathogens (16.97%), followed by Enterobacter sp (11.99%) and Pseudomonas sp (11.62%). In the late post-transplant period, community-acquired pathogens Streptococcus pneumoniae (6.27%) and Haemophilus influenzae (2.82%) were also commonly identified. Patients' characteristics independently associated with acquisition of bacterial infection included younger age (p < 0.0001) and ventilator (p < 0.0001) or extracorporeal membrane oxygenation (p = 0.03) use at time of transplant. Overall mortality post-bacterial infection was 33.78%, and previous cardiac surgery (p < 0.001) and multiple sites of infection (p = 0.004) were independent predictors of death.

Conclusions: Bacteria were the most common causes of severe infections in pediatric heart transplant recipients and were associated with high mortality rates. The risk of acquiring a bacterial infection was highest in the first month post-transplant, and a large proportion of the infections were caused by multidrug-resistant pathogens.

Keywords: bacterial; heart transplant; infection; pediatric.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Age Distribution
  • Bacterial Infections / diagnosis*
  • Bacterial Infections / epidemiology*
  • Bacterial Infections / therapy
  • Cause of Death*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Confidence Intervals
  • Databases, Factual
  • Female
  • Heart Transplantation / adverse effects*
  • Heart Transplantation / methods
  • Heart Transplantation / mortality
  • Humans
  • Incidence
  • Male
  • Multivariate Analysis
  • Outcome Assessment, Health Care
  • Postoperative Complications / epidemiology
  • Postoperative Complications / microbiology
  • Postoperative Complications / physiopathology
  • Proportional Hazards Models
  • Retrospective Studies
  • Severity of Illness Index
  • Sex Distribution
  • Survival Analysis
  • United States / epidemiology