Clinical and economic burden of infections in hospitalized solid organ transplant recipients compared with the general population in Canada – a retrospective cohort study

Abstract

Infections continue to be a major cause of post-transplant morbidity and mortality, requiring increased health services utilization. Estimates on the magnitude of this impact are relatively unknown. Using national administrative databases, we compared mortality, acute care health services utilization, and costs in solid organ transplant (SOT) recipients to nontransplant patients using a retrospective cohort of hospitalizations in Canada (excluding Manitoba/Quebec) between April-2009 and March-2014, with a diagnosis of pneumonia, urinary tract infection (UTI), or sepsis. Costs were analyzed using multivariable linear regression. We examined 816 324 admissions in total: 408 352 pneumonia; 328 066 UTI's; and 128 275 sepsis. Unadjusted mean costs were greater in SOT compared to non-SOT patients with pneumonia []. Mortality (7.6% vs. 12.5%; P < 0.001), long-term care transfer (5.3% vs. 16.5%; P < 0.001), and mean length of stay (11.0 AE 17.7 days vs. 13.1 AE 24.9 days; P < 0.001) were lower in SOT. More SOT patients could be discharged home (63.2% vs. 44.3%; P < 0.001), but required more specialized care (23.5% vs. 16.1%; P < 0.001). Adjusting for age and comorbidities, hospitalization costs for SOT patients were 10% (95% CI: 8-12%) lower compared to non-SOT patients. Increased absolute hospitalization costs for these infections are tempered by lower adjusted costs and favorable clinical outcomes.

Sepsis outcomes in solid organ transplant recipients

“…They did not report mortality in transplant subgroups and it is possible that a large, less sick kidney transplant population could have contributed to a lower mortality. Hamandi et al published a large retrospective cohort study from Canada, and they also found lower mortality in SOT groups compared with the general population (7.6% vs 12.5%) but SOT patients had higher acute care health services utilization and costs . Readmissions and hospital length of stay were longer in the SOT population in our study suggestive of higher healthcare cost and utilization.…”

“…16 In our study, sepsis-associated organ failure rates were higher in all the transplant groups; however, it did not adversely affect overall cohort study from Canada, and they also found lower mortality in SOT groups compared with the general population (7.6% vs 12.5%) but SOT patients had higher acute care health services utilization and costs. 23 Readmissions and hospital length of stay were longer in the SOT population in our study suggestive of higher healthcare cost and utilization.…”

Survival Outcome of Sepsis in Recipients of Solid Organ Transplant

“…3 In contrast to the study by Gotur et al, in a Canadian study, Hamandi et al showed that length of stay and the rates of home discharge were more favorable to SOT recipients. 1 Similar to above mentioned study, in a study focused on liver transplant recipients only, Wang et al showed that sepsis was associated with higher mortality, prolonged mechanical ventilation, and increased requirement for renal replacement therapy. All these finding were reflecting in greater economic burden in SOT recipients with sepsis.…”

“…Infectious diseases specialists are often consulted for the management of infections, leading to fast treatment of sepsis with antibiotics, antifungals, and vascular resuscitation. 1,9,21 The study published by Kalil et al showed that SOT patients had similar rate of septic shock with non-SOT patients (p ¼ 0.241) but higher SOFA score (p < 0.0001), and they were more likely to have multiorgan failure (p < 0.001). 9 SOT recipients compared with non-SOT patients have lower platelets (p < 0.001) and white blood cell counts (p ¼ 0.032), on presentation, were more likely to have a nosocomial infection (p < 0.0001) and less likely to receive appropriate initial empiric treatment (p < 0.001).…”

“…In the last few years, a growing body of evidence suggests the contrary. 1,9,10 When we evaluate the recently published studies, we need to keep in mind that the majority of the studies evaluated risk factors and outcomes of sepsis in SOT with bloodstream infections. Even more, the current definition of sepsis is not comprehensive and has not been validated for SOT recipients.…”