Epidemiology and Clinical Features of Post-Transplant Bloodstream Infection: An Analysis of 222 Consecutive Liver Transplant Recipients

Abstract

BackgroundBloodstream infection (BSI) is a significant cause of morbidity and mortality in liver transplant (LT) recipients. This study aimed to investigate the epidemiology and clinical features of post-transplant BSI in LT recipients.Materials and MethodsThe microbiology, frequency, and outcome of post-transplant BSI in the first year after LT were retrospectively analyzed in 222 consecutive patients who had received liver transplants at a single center between 2005 and 2011. The risk factors for post-transplant BSI and death were evaluated.ResultsDuring a 1-year period after LT, 112 episodes of BSI occurred in 64 of the 222 patients (28.8%). A total of 135 microorganisms were isolated from 112 BSI episodes including 18 polymicrobial episodes. The median time to BSI onset ranged from 8 days for Klebsiella pneumoniae to 101 days for enterococci, and the overall median for all microorganisms was 28 days. The most frequent pathogens were Enterobacteriaceae members (32.5%), enterococci (17.8%), yeasts (14.0%), Staphylococcus aureus (10.3%), and Acinetobacter baumannii (10.3%); most of them showed resistance to major antibiotics. The major sources of BSI were biliary tract (36.2%), abdominal and/or wound (28.1%), and intravascular catheter (18.5%) infections. The independent risk factors for post-transplant BSI were biliary complications (odds ratio [OR]: 2.91, 95% confidence interval [CI]: 1.29 to 6.59, P = 0.010) and longer hospitalization in the intensive care unit (OR: 1.04, 95% CI: 1.00 to 1.08, P < 0.001) after LT. BSI was an independent risk factor for death (hazard ratio [HR]: 3.92, 95% CI: 2.22 to 6.91, P < 0.001), with a poorer survival rate observed in patients with BSI than in those without BSI (1-year survival rate: 60.0% versus 89.5%, respectively, P < 0.001) after LT. The strongest predictors for death in patients with BSI were hepatocellular carcinoma (HR: 3.82, 95% CI: 1.57 to 9.32, P = 0.003), candidemia (HR: 3.71, 95% CI: 1.58 to 8.71, P = 0.003), polymicrobial bacteremia (HR: 3.18, 95% CI: 1.39 to 7.28, P = 0.006), and post-transplant hemodialysis (HR: 2.44, 95% CI: 1.02 to 5.84, P = 0.044).ConclusionsBSI was a frequent post-transplant complication, and most of the causative pathogens were multi-drug resistant. Biliary complications and BSIs resulting from biliary infection are major problems for LT recipients. The prevention of BSI and biliary complications is critical in improving prognosis in liver transplant recipients.

Different scenarios for Candida parapsilosis fungaemia reveal high numbers of mixed C. parapsilosis and Candida orthopsilosis infections

“…A previous study reported two cases of polyfungal infections (C. albicans and Candida glabrata) in 20 hospitalized patients with catheterrelated candidaemia; however, none of the C. parapsilosis complex species was involved in polyfungal infections (Escribano et al, 2014). It has been reported that polymicrobial BSIs are strongly associated with increased mortality (Kim et al, 2013). Although there is no study to date regarding the survival of patients infected with C. parapsilosis and C. orthopsilosis, the identification of BSI due to more than one species is of extreme importance.…”

Bacterial Pathogens Isolated in Liver Transplant Recipients With Surgical Site Infection and Antibiotic Treatment

“…In this study, 50.7% of the LTRs had a blood stream infection, 22.5% had pneumonia, and 14.0% had a urinary tract infection. It has been explained in the literature that the primary source in LTRs with blood circulation infection was abdominal or wound infection at the rate of 28.1% and biliary tract infection at the rate of 36.2% in the first year after transplantation [15]. In our study, only 1 patient had biliary complications within 30 days after transplantation.…”

“…Kim et al [15] also emphasized that reoperative episodes were meaningful risk factors for BSI. In spite of being pointed out that reoperation was a risk for infections, its effect on the treatment has not been mentioned.…”

Septic arthritis in immunocompetent and immunosuppressed hosts

“…In the first few weeks after transplantation, joint infections are often hematogenous and caused by health-care-associated pathogens such as S. aureus (including MRSA) and gram-negative bacilli including P. aeruginosa [85,86]. However, in the months following transplantation, as patients are maintained on immunosuppressive therapy, they are more prone to infections caused by fungi and mycobacteria.…”