Invasive surgical site infections after lung transplantation: contemporary risk factors and associated clinical outcomes

Invasive surgical site infections after lung transplantation: contemporary risk factors and associated clinical outcomes

Background: Invasive primary surgical site infections (IP-SSI) complicate lung transplant (LT) surgery. Identification of IP-SSI risk factors is critical to IP-SSI prevention. Methods: This single-center retrospective cohort study of adult patients who underwent LT at Duke University over a 5-year p...

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Main Authors: Manuela Carugati, MD, Sana Arif, MD, John Michael Reynolds, MD, John Carroll Haney, MD, Michael Edwards Yarrington, MD, MM, Katherine Young, MD, Deepika Kulkarni, MD, Alzora Benjamin, Katina Walline, Jonathan Huggins, MD, MSCE, Morgan Rosser, PhD, Samantha Morrison, PhD, Sarah Peskoe, PhD, Brandi Ann Bottiger, MD, Rachel Ann Miller, MD, Barbara Dudley Alexander, MD, MHS
Format: Article
Language:English
Published: Elsevier 2025-08-01
Series:JHLT Open
Subjects:
Lung transplant
Lung transplantation
Surgical site infections
Infections
Antimicrobial prophylaxis
Online Access:http://www.sciencedirect.com/science/article/pii/S2950133425000898
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Summary:Background: Invasive primary surgical site infections (IP-SSI) complicate lung transplant (LT) surgery. Identification of IP-SSI risk factors is critical to IP-SSI prevention. Methods: This single-center retrospective cohort study of adult patients who underwent LT at Duke University over a 5-year period (2017–2021) aimed to identify IP-SSI risk factors and describe outcomes associated with IP-SSI diagnosis. IP-SSI risk factors were identified using a Least Absolute Shrinkage and Selection Operator procedure for logistic regression. Results: IP-SSI occurred in 74/568 (13.0%) LT recipients. Restrictive lung disease, donor positive respiratory or blood cultures, operative time, post-transplant thoracic re-operation within 90 days of transplant, and ECMO by day 3 post-transplant were positively associated with IP-SSI. Obstructive lung disease, primary closure, and enhanced immunosuppression within 90 days of transplant were negatively associated with IP-SSI. Patients with IP-SSI were descriptively characterized by longer index transplant hospitalizations (92 vs. 22 days) and higher in-hospital (26.1% vs. 5.5%) and 1-year (20.3% vs. 12.1%) mortality rates than patients without IP-SSI. IP-SSI was significantly associated with 1-year mortality (HR 2.4, 1.3–4.3, p=0.003); however, the association was no longer significant (HR 1.4, 0.7–2.6, p=0.310) after adjusting for possible confounders. Conclusions: Conservative surgical approaches, targeted antimicrobial prophylaxis, and increased surveillance for patients with IP-SSI risks may play a critical roleto limit IP-SSI in the LT population.
ISSN:2950-1334

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