Abstract Rationale Empiric antimicrobial selection in orthotopic heart transplantation (OHT) is of critical importance as post-operative infections are a significant cause of morbidity and mortality. While variability of antimicrobial selection exists between centers, both combinations of vancomycin and piperacillin-tazobactam (VPT) and vancomycin and cefepime (VC) are frequently used. VPT drug combination has been associated with increased risk of AKI in multiple reports. Our study aimed to evaluate the infectious impact of changing the empiric antimicrobial selection from VPT to VC. Methods This was a single-center study in patients undergoing OHT at Medical University of South Carolina (MUSC) between 2015 and 2021 (n = 120). As part of a quality improvement measure to improve renal outcomes, the empiric intraoperative antimicrobial was transitioned from VPT (n = 48) to VC (n = 72) in 2019, providing a prospective setting to investigate infectious outcomes. Results 10.4% of patients receiving VPT had a positive culture within 30 days of OHT, compared to 9.7% of patients receiving VC (p = 0.781). No statistical difference in site of infection (blood, urine, respiratory, or wound) was identified between groups (p = 0.487). There was no significant difference in temporal proximity of infection to OHT, with positive cultures at a median of 28 days for patients receiving VPT and a median of 14 days for patients receiving VC (p = 0.08). Conclusion Rates and site of infection were similar between OHT patients receiving empiric intraoperative VPT and VC. This abstract is funded by: DCI
Golbus et al. (Fri,) studied this question.
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