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Bloodstream infections in liver transplant recipients receiving tacrolimus
N Singh1, T Gayowski, M M Wagener
1VA Medical Center, Infectious Disease Section, Pittsburgh, PA 15240, USA.
Abstract:
The microbial origin, timing, risk factors, and outcome of bloodstream infections (bacteremia and fungemia) were prospectively analyzed in 130 consecutive liver transplant recipients receiving tacrolimus-based immunosuppression; median followup was 3 yr. 22% (29/130) of the patients developed 36 episodes of bloodstream infections (0.28 episodes/patient). Bloodstream infections accounted for 36% (36/100) of all major infections. 81% (29/36) of bloodstream infections were due to bacteremia and 19% (7/36) due to fungemia (candidemia 14% and cryptococcemia 5%). Intravascular catheters were the most frequent source and methicillin-resistant Staphylococcus aureus was the most frequent pathogen causing bloodstream infections. 70% of the catheter related and all bacteremias due to intra-abdominal infections occurred < or = 90 d, whereas 75% of the bacteremias due to biliary source occurred > 90 d after transplantation. Length of initial post-transplant intensive care unit stay (p = 0.014) and readmission to the intensive care unit (p = 0.003) were independently significant predictors of bloodstream infections. 40% of the candidemias occurred within 30 d of transplantation and were of unknown portal, whereas the portal in all candidemias occurring > 30 d post-transplant was known (catheter, hepatic abscess, urinary tract). Mortality in patients with bloodstream infections was 52% (15/29) vs. 9% (9/101) in patients without bloodstream infections (p = 0.0001). In conclusion, intravascular catheters (and not intra-abdominal infections) have emerged as the most common source of bloodstream infections, and gram-positive cocci (S. aureus) as the predominant pathogens in bloodstream infections after liver transplantation.
Insights
Bloodstream infections are common after liver transplants, often originating from catheters and caused by Staphylococcus aureus. These infections significantly increase mortality risk in transplant recipients.
Area of Science:
- Infectious Diseases
- Transplantation Medicine
- Microbiology
Background:
- Liver transplant recipients on tacrolimus-based immunosuppression are susceptible to bloodstream infections.
- Bloodstream infections represent a significant proportion of major infections post-transplant.
Purpose of the Study:
- To prospectively analyze the microbial origin, timing, risk factors, and outcomes of bloodstream infections in liver transplant recipients.
- To identify common pathogens and sources of bloodstream infections in this patient population.
Main Methods:
- Prospective analysis of 130 liver transplant recipients over a median follow-up of 3 years.
- Detailed recording of bloodstream infection episodes, including microbial origin, timing, source, and patient outcomes.
Main Results:
- 22% of patients developed 36 bloodstream infection episodes; 81% were bacteremia, 19% fungemia.
- Intravascular catheters were the most frequent source, and methicillin-resistant Staphylococcus aureus the most frequent pathogen.
- Increased intensive care unit stay and readmission were significant predictors; mortality was 52% in infected patients versus 9% in non-infected.
Conclusions:
- Intravascular catheters are the primary source of bloodstream infections post-liver transplant.
- Gram-positive cocci, particularly Staphylococcus aureus, are the predominant pathogens.
- Bloodstream infections are associated with significantly higher mortality in liver transplant recipients.