SIGNIFICANCE OF POSITIVE CULTURES FROM DONOR LEFT ATRIUM AND POSTPRESERVATION FLUID IN HEART-TRANSPLANTATION

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.