Bacteremia During the First Year After Solid Organ Transplantation: An Epidemiological Update

Abstract

Background There are limited contemporary data on the epidemiology and outcomes of bacteremia in solid organ transplant recipients (SOTr). Methods Using the Swiss Transplant Cohort Study registry from 2008 to 2019 we performed a retrospective nested multi-center cohort study to describe the epidemiology of bacteremia in SOTr during the first-year post-transplant. Results Of 4383 patients, 415 (9.5%) with 557 bacteremia due to 627 pathogens were identified. One-year-incidence was 9.5%, 12.8%, 11.4%, 9.8%, 8.3%, and 5.9% for all, heart, liver, lung, kidney, and kidney-pancreas SOTr, respectively (P = 0.003). Incidence decreased during the study period (HR: 0.66, P < 0.001). One-year-incidence due to Gram-negative bacilli (GNB), Gram-positive cocci (GPC), and Gram-positive bacilli (GPB) was 5.62%, 2.81%, and 0.23%, respectively. Seven (of 28, 25%) S. aureus isolates were methicillin-resistant, 2/67 (3%) enterococci were vancomycin-resistant and 32/250 (12.8%) GNB produced extended-spectrum beta-lactamases. Risk factors for bacteremia within one-year post-transplant included age, diabetes, cardiopulmonary diseases, surgical/medical post-transplant complications, rejection and fungal infections. Predictors for bacteremia during the first 30-days post-transplant included surgical post-transplant complications, rejection, deceased donor, liver and lung transplantation. Transplantation in 2014-2019, CMV donor-negative/recipient-negative serology, and cotrimoxazole Pneumocystis-prophylaxis were protective against bacteremia. Thirty-day mortality in SOTr with bacteremia was 3% and did not differ by SOT type. Conclusions Almost 1/10 SOTr may develop bacteremia during the first year post-transplant associated with low mortality. Lower bacteremia rates were observed since 2014 and in patients receiving cotrimoxazole prophylaxis. Variabilities in incidence, timing, and pathogen of bacteremia across different SOT types may be used to tailor prophylactic and clinical approaches.

Can the Pan-immune-inflammation Value Predict Gram Negative Bloodstream Infections-related 30-day Mortality in Solid Organ Transplant Recipients?

“…Escherichia coli and K. pneumoniae were the predominant GN bacteria among these SOT population with BSI. Although the spectrum of bacteria varies between centers, similar results were found with other studies [18,20,21,23]. The prevalence of CR-GN bacteria was %35.6 in study cohort but it was detected in 84.2% of the deceased patients, and in 69.2% of the patients who had liver transplants, a nding consistent with prior reports [18][19][20].…”

“…The distribution of infections seen in SOT patients is proportionate to the anatomic position of the transplanted organ. While urinary tract infection is more commonly found in renal transplant patients, surgical site and intra-abdominal infections are reported in liver transplant patients [21]. Escherichia coli and K. pneumoniae were the predominant GN bacteria among these SOT population with BSI.…”

“…There is an increased risk of infections caused by these bacteria in patients who have received SOT [19]. The main risk factors for drug resistant GN-BSI in SOT patients are frequent and prolonged hospitalization, antibiotic use (for treatment or antimicrobial prophylaxis), immunosuppression, surgical operations, and the presence of other comorbidities [19][20][21]. For appropriate antibiotic selection and patient management, it is essential to comprehend infection dynamics and risk factors associated with GN-BSI.…”

Bloodstream infections after solid organ transplantation: clinical epidemiology and antimicrobial resistance (2016–21)

“… 4 Incidence in our study was very similar to a recent report from Switzerland, which found overall incidence of 9.5%, including 11.4% among liver transplant recipients. 24 Although the Danish study used a relatively contemporaneous time period (2010–17), we report consistently lower incidence of BSI than older studies that focused on liver 5 , 6 , 25–27 and kidney transplant recipients. 17 Some of this variation may reflect geographical differences, although improved infection control practices, as well as the experience of our large-volume transplant centre, may explain the apparent improvement in trends over time.…”

Gram-negative bacteremia - 55 years later

“…8 They concluded that FQ prophylaxis did not affect the incidence of GNB bacteremia, hospitalization time, acute graft-versushost disease, and overall survival post-allo-HCT.8 Neofytos D, et al reviewed the epidemiology and outcomes of 557 cases of bacteremia in 4383 recipients in the first year post-solid organ transplant (SOTr); 627 pathogens were found, the one-year incidence of BSI by GNB was 5.62%, Enterococci (3%) were vancomycinresistant, and GNB (12.8%) were extended-spectrum β-lactamase (ESBL). 9 Predictors for bacteremia during the first 30 days after transplant included surgical posttransplant complications, rejection, deceased donor, and liver and lung transplantation. Thirty-day mortality in SOTr with bacteremia was 3% and did not differ by SOT type, near 1/10 SOTr may have bacteremia with low mortality in the post-transplant first year, and lower bacteremia rate was observed in patients receiving cotrimoxazole prophylaxis.…”