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Bacteremias in liver transplant recipients: shift toward gram-negative bacteria as predominant pathogens

Nina Singh1, Marilyn M Wagener, Asia Obman

  • 1Veterans Affairs Medical Center, Pittsburgh, PA 15240, USA. nis5+@pitt.edu

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
|July 9, 2004
PubMed

Insights

Bacteremia infections in liver transplant recipients have significantly increased. Gram-negative bacteria now dominate, replacing gram-positive bacteria as the leading cause of bacteremia in these patients.

Area of Science:

  • Infectious Diseases
  • Transplantation Medicine
  • Microbiology

Background:

  • Gram-positive bacteria were major pathogens in liver transplant recipients during the 1990s.
  • Changes in pathogen prevalence over time require investigation.

Purpose of the Study:

  • To determine if the pathogens causing bacteremia in liver transplant recipients have changed between 1989 and 2003.

Main Methods:

  • Retrospective analysis of 233 liver transplant recipients.
  • Comparison of infection types and causative pathogens over distinct time periods (1989-1993 vs. 1998-2003).

Main Results:

  • Bacteremias significantly increased as a proportion of all infections over time (P <.0001).
  • Fungal infections and cytomegalovirus (CMV) disease significantly decreased.
  • The proportion of bacteremias due to gram-negative bacteria rose from 25% to 51.8%, while gram-positive bacteria decreased from 75% to 48.2%.
  • Klebsiella pneumoniae and Pseudomonas aeruginosa emerged as frequent pathogens, with a notable increase in enteric gram-negative bacteria.

Conclusions:

  • Bacteremias represent an increasing proportion of infections in liver transplant recipients.
  • Gram-negative bacteria have become the predominant pathogens causing bacteremia in this population.
  • Declines in fungal and CMV infections contributed to the relative increase in bacteremia.

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