High mortality related with Staphylococcus aureus bacteremia after liver transplantation

The aim of the present study was to analyze the characteristics of bacteremia occurring in liver-transplant patients in Andalusia, Spain, during the 1990s. At the three participating hospitals, 405 liver transplantations were performed during the study period, and 119 bacteremic episodes were observed following 91 of them (22.4%, 29.4 episodes/100 liver transplants). Gram-positive organisms were the predominant bacteria isolated in cases of early-onset bacteremia (70.7%, P=0.04). The most common sources of bacteremia were the abdomen (33.6%) and intravascular catheters (22.7%), but frequently the source of bacteremia was unknown (31.9%). Mortality at 30 days was 21%. Isolation of Staphylococcus aureus was the only independent risk factor for mortality (relative risk, 3.13; 95% confidence interval, 1.3-7.5; P=0.01). These results indicate that control measures are required in order to reduce the incidence of gram-positive bacteremia and catheter-related infection in this patient population. The observed etiology must be considered when empirical antimicrobial therapy is indicated while awaiting blood-culture results.