Sb. Mossad et al., SIGNIFICANCE OF POSITIVE CULTURES FROM DONOR LEFT ATRIUM AND POSTPRESERVATION FLUID IN HEART-TRANSPLANTATION, Transplantation, 64(8), 1997, pp. 1209-1210
Background The significance of positive perioperative cultures routine
ly obtained from the donor left atrium and postpreservation fluid duri
ng heart transplantation is unknown. Methods. A retrospective chart re
view of 128 heart transplant recipients was done. Results. A total of
106 of 128 patients had left atrial and/or postpreservation fluid cult
ures performed; 61 (57.5%) of them were positive. Forty-one positive l
eft atrial or postpreservation cultures grew indolent organisms and 20
grew virulent organisms. Six donors had positive blood cultures, and
five of the six did not have left atrial or postpreservation fluid cul
tures positive for the same organism, Seven recipients had positive bl
ood cultures with organisms different from their corresponding left at
rial or postpreservation fluid cultures. Three patients had sternal wo
und infections with organisms different from their donors' left atrial
or postpreservation fluid cultures. Seven patients received additiona
l antibiotics after heart transplantation specifically directed at a p
ositive left atrial or postpreservation fluid culture for 5 to 7 days;
none of them developed infection with these organisms. Conclusions. W
e found no evidence that positive donor left atrium or postpreservatio
n fluid cultures increase the recipients' risk of infection. Neverthel
ess, we cannot refute that the small group of patients who received ad
ditional antibiotics might have developed an infection if they had not
been treated. We recommend that the left atrial and postpreservation
fluid cultures growing indolent organisms be discounted. However, if t
hey grow more virulent organisms, consideration could be given to a br
ief course of specific therapy while awaiting recipient cultures.