Epidemiology and outcome of Gram-positive bloodstream infection in solid organ transplant recipients
Abstract number: P1411
Fernández-Ruiz M., Linares L., Cervera C., Almela M., Tuset M., Cofán F., Ricart M.J., Navasa M., Escorsell A., Roig E., Moreno A.
Aim: Bloodstream infection (BSI) is one of the most frequent complication in solid-organ transplantation (SOT) recipients. Our aim is to estimate the incidence, outcomes and risk factors for Gram-positive BSI in this population.
Methods: Prospective cohort study in the period between July, 2003 and December, 2007, including patients receiving renal, liver, heart and simultaneous double-organ transplantation. Demographics, underlying conditions, immunosuppressive schemes, and post-transplant complications were prospective collected. BSI was defined as significant according to the CDC criteria. BSI-related mortality was defined as a death occurring within the first 30 days. Multivariate logistic regression analysis was performed to identify variables associated with Gram-positive BSI after SOT.
Results: A total of 1,049 SOT were performed in the study period (528 kidney, 318 liver, 83 heart, and 120 double transplant). We diagnosed 186 recipients (17.7%) with at least one episode of Gram-positive infection. There were 72 episodes of Gram-positive BSI in 64 patients (6.1% of global cohort). The cumulative incidence according to the type of SOT was: kidney (2.6%), liver (12.5%), heart (2.4%) and double transplant (6.6%) (p < 0.001). The most frequent source of BSI was catheter-related (40.3%). Thirty-nine percent of episodes occurred during the first month after transplantation. Isolated species were: methicillin-resistant coagulase-negative staphylococci (CoNS) (27.8%), Enterococcus faecalis (23.6%), methicillin-susceptible CoNS (16.7%), methicillin-susceptible Staphylococcus aureus (12.5%), Enterococcus faecium (8.3%), methicillin-resistant S. aureus (MRSA) (1.2%), and others (9.9%). Vancomycin (29% of episodes) and teicoplanin (22%) figured as the most common first-line treatments. Multivariate analysis revealed as independent risk factors for Gram-positive BSI: liver transplantation (OR 3.74, CI 95% 2.186.39) and re-operation (OR 2.79, CI 95% 1.654.3). Twenty-three of 64 patients with Gram-positive BSI (35.9%) deceased, including 9 cases with related mortality.
Conclusion: The incidence of Gram-positive BSI after SOT was high, specifically in liver transplant recipients. Type of transplant and re-operation revealed as independent risk factors for the occurrence of such complication. Our results provide preliminary evidence of the decreasing prevalence of MRSA as a cause of BSI in SOT recipients, and the emergence of Enterococcus in this group of patients.
|Session name:||Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Vienna, Austria, 10 - 13 April 2010|
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