Invasive surgical site infections after lung transplantation: contemporary risk factors and associated clinical outcomes.
Date
2025-08
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Abstract
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.Type
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Publication Info
Carugati, Manuela, Sana Arif, John Michael Reynolds, John Carroll Haney, Michael Edwards Yarrington, Katherine Young, Deepika Kulkarni, Alzora Benjamin, et al. (2025). Invasive surgical site infections after lung transplantation: contemporary risk factors and associated clinical outcomes. JHLT open, 9. p. 100294. 10.1016/j.jhlto.2025.100294 Retrieved from https://hdl.handle.net/10161/33594.
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Scholars@Duke
Manuela Carugati
Sana Arif
John Michael Reynolds
Michael Yarrington
Katherine Young
Deepika Prasad Kulkarni
Jonathan Huggins
Samantha Morrison
Education: PhD, Biostatistics -- Brown University, 2021
Samantha collaborates with clinicians and researchers in the Department of Radiology, the Duke Transplant Center, and the Division of Pulmonary, Allergy, and Critical Care Medicine in the Department of Medicine. Her research focuses on development and evaluation of prediction models in the presence of incomplete outcome data. Her areas of interest include machine learning methods and survival analysis.
Sarah Peskoe
Sarah collaborates with researchers, clinicians, and fellows in the Center for the Study of Aging and Human Development, the Department of Surgery, and the Department of Medicine. Her methodological research involves correcting for biases arising in epidemiologic research, primarily as a result of measurement error and selection. Sarah's main areas of interest include biomarker evaluation, electronic health records-based research, risk prediction, and survival analysis.
Brandi Anne Bottiger
I have been a member of the Cardiothoracic Anesthesiology division and Department of anesthesiology since 2011, caring for cardiac and thoracic surgical patients. I am the current anesthesiology residency director, and past cardiothoracic anesthesiology fellowship director, past medical director of transplant quality at the Duke Transplant Center. My academic interests are in education, CTA content development, and outcomes improvement after lung transplantation.
Rachel Ann Miller
Barbara Dudley Alexander
Clinical research related to infectious complications of solid organ and bone marrow transplantation, with a particular interest in the treatment and rapid diagnosis of fungal disease. Training the next generation of Transplant Infectious Disease Physicians is a special focus of mine as the Principal Investigator of our Interdisciplinary T32 Training Program funded the NIH.
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