INFECTIVE ENDOCARDITIS IN SOLID-ORGAN TRANSPLANT RECIPIENTS

Infective endocarditis, defined as pathologically or clinically defini te by the Duke criteria, was observed in 14 transplant recipients at o ur institutions. In addition, we reviewed 32 previously reported cases in solid organ transplant recipients, The spectrum of organisms causi ng infective endocarditis was clearly different in transplant recipien ts than in the general population; 50% of the infections were due to A spergillus fumigatus or Staphylococcus aureus, but only 4% were due to viridans streptococci, Fungal infections predominated early (accounti ng for six of 10 cases of endocarditis within 30 days of transplantati on), while bacterial infections caused most cases (80%) after this tim e. In 80% (37) of the 46 cases in transplant recipients, there was no underlying valvular disease, Seventy-four percent (34) of the 46 cases were associated with previous hospital-acquired infection, notably ve nous access device and wound infections. Three patients with S. aureus endocarditis had had an episode of S. aureus bacteremia >3 weeks prio r to the diagnosis of endocarditis and had received treatment for the initial bacteremia of <14 days' duration, The overall mortality rate w as 57% (26 of 46 patients died), with 58% (15) of the 26 fatal cases n ot being suspected during life. Endocarditis is an underappreciated se quela of hospital-acquired infection in transplant recipients.