Epidemiology and impact of bloodstream infections among kidney transplant recipients: A retrospective single‐center experience

Shendi, Ali; Wallis, Gabriel; Painter, Helena; Harber, Mark; Collier, Sophie

doi:10.1111/tid.12815

Cited by 27 publications

(29 citation statements)

References 29 publications

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“…As prior studies reported[ 2 , 26 , 27 ], the most frequent sources of BSIs in our study were intra-abdominal and biliary tract in GNB group. Intra-abdominal infection largely occurred in the first 3 mo, while cholangitis was the major source of BSI at later time.…”

Section: Discussionsupporting

confidence: 72%

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High mortality associated with gram-negative bacterial bloodstream infection in liver transplant recipients undergoing immunosuppression reduction

Chen

Pang

Shen

et al. 2020

WJG

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BACKGROUND Immunosuppression is an important factor in the incidence of infections in transplant recipient. Few studies are available on the management of immunosuppression (IS) treatment in the liver transplant (LT) recipients complicated with infection. The aim of this study is to describe our experience in the management of IS treatment during bacterial bloodstream infection (BSI) in LT recipients and assess the effect of temporary IS withdrawal on 30 d mortality of recipients presenting with severe infection. AIM To assess the effect of temporary IS withdrawal on 30 d mortality of LT recipients presenting with severe infection. METHODS A retrospective study was conducted with patients diagnosed with BSI after LT in the Department of Liver Surgery, Renji Hospital from January 1, 2016 through December 31, 2017. All recipients diagnosed with BSI after LT were included. Univariate and multivariate Cox regression analysis of risk factors for 30 d mortality was conducted in the LT recipients with Gram-negative bacterial (GNB) infection. RESULTS Seventy-four episodes of BSI were identified in 70 LT recipients, including 45 episodes of Gram-positive bacterial (GPB) infections in 42 patients and 29 episodes of GNB infections in 28 patients. Overall, IS reduction (at least 50% dose reduction or cessation of one or more immunosuppressive agent) was made in 28 (41.2%) cases, specifically, in 5 (11.9%) cases with GPB infections and 23 (82.1%) cases with GNB infections. The 180 d all-cause mortality rate was 18.5% (13/70). The mortality rate in GNB group (39.3%, 11/28) was significantly higher than that in GPB group (4.8%, 2/42) ( P = 0.001). All the deaths in GNB group were attributed to worsening infection secondary to IS withdrawal, but the deaths in GPB group were all due to graft-versus-host disease. GNB group was associated with significantly higher incidence of intra-abdominal infection, IS reduction, and complete IS withdrawal than GPB group ( P < 0.05). Cox regression showed that rejection (adjusted hazard ratio 7.021, P = 0.001) and complete IS withdrawal (adjusted hazard ratio 12.65, P = 0.019) were independent risk factors for 30 d mortality in patients with GNB infections after LT. CONCLUSION IS reduction is more frequently associated with GNB infection than GPB infection in LT recipients. Complete IS withdrawal should be cautious due to increased risk of mortality in LT recipients complicated with BSI. IS

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Section: Discussionsupporting

confidence: 72%

“…The common pathogens of infection after LT include E. coli , Klebsiella , Enterobacter , and S. marcescens [ 27 , 33 ]. P. aeruginosa and A. baumannii are also common causes of GNB infection.…”

Section: Discussionmentioning

confidence: 99%

High mortality associated with gram-negative bacterial bloodstream infection in liver transplant recipients undergoing immunosuppression reduction

Chen

Pang

Shen

et al. 2020

WJG

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“…Significantly, recent reports have shown a shift towards gram-negative bacteria (GNB) in the distribution of the pathogens that cause bloodstream infection (BSI) in the SOT recipients [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of extensively drug-resistant gram-negative bacteremia among solid-organ transplant recipients: a multicenter study

et al. 2021

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Background/aim: The aim of this study is to evaluate the distribution, sources, clinical features, and mortality rates of bacteremia due to evaluation of extensively drug-resistant (XDR) gram negative among solid-organ transplant (SOT) recipients. Materials and methods:A retrospective study of SOT recipients with bacteremia due to XDR gram-negative pathogens in 11 centers between 2016 and 2018 was conducted. Patients' records were evaluated.Results: Of 171 bacteremia that occurred in 164 SOT recipients, 93 (56.7%) were liver, 46 (28%) kidney, 14 (8.5%) heart, and 11 (6.7%) lung recipients. Bacteremia episodes were recorded in the first year in 63.7% of the patients (n = 109), early-onset bacteremia was recorded in 45% (n = 77) of the episodes. In multivariate analysis, catheter-associated bacteremia was an independent risk factor for 7-day mortality (p = 0.037), and early-onset bacteremia was found as an independent risk factor for 30-day mortality (p = 0.017). Conclusion:Difficult-to-treat infections due to XDR bacteria in SOT recipients shadow the success of transplantation. Central venous catheters seem to be the main risk factor. Judicious use of medical devices is of pivotal importance.

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“…Nosocomial infection is a great threat among ASOT recipients. In previous studies, Shendi et al and Lee et al found that high resistance to antibacterial agents among ASOT recipients was associated with a high rate of nosocomial origins [ 31 , 32 ]. In accordance with our previous study based on ASOT recipients with drug-resistant gram-negative infections, we observed that in the present cohort, based on survival analysis, nosocomial infection induced a significant increase in mortality [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Acquisition of Carbapenem-Resistant Klebsiella pneumoniae and Mortality Among Abdominal Solid Organ Transplant Recipients with K. pneumoniae Infections

Chen

Liu

et al. 2020

Med Sci Monit

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Background For abdominal solid organ transplant (ASOT) recipients, infection with Klebsiella pneumoniae , particularly carbapenem-resistant K. pneumoniae (CRKP), can be life-threatening. The aims of this study were to characterize the risk factors associated with acquisition of CRKP and 90-day crude mortality among patients. Material/Methods In our cohort study, we retrospectively reviewed 68 K. pneumoniae -infected transplant recipients, studied their demographics, clinical manifestations, microbiology, and outcomes, and determined the risk factors associated with the occurrence of CRKP and crude mortality due to K. pneumoniae infections. Results Sixty-eight ASOT recipients (5.4%) experienced 78 episodes of K. pneumoniae infection. Among these, 20 patients (29.4%) died. The independent risk factors associated with mortality were multiple infected organs or sites (odds ratio=22.034, 95% confidence intervals=4.348–111.653, P =0.001) and septic shock (odds ratio=27.090, 95% confidence intervals=1.841–398.512, P =0.016). Risk factors associated with acquisition of CRKP were multiple infected organs or sites (odds ratio=3.056, 95% confidence intervals=1.091–8.556, P =0.033). Conclusions K. pneumoniae infections, especially CRKP, frequently occurred among ASOT recipients, with a high mortality rate. Multiple infected organs or sites and septic shock were predictors of crude mortality caused by K. pneumoniae infections, while CRKP infections were associated with multiple infected organs or sites. Greater efforts are needed towards improved antibiotic administration, early diagnosis and precise treatment, recognition of septic shock, and reduced length of hospitalization.

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Epidemiology and impact of bloodstream infections among kidney transplant recipients: A retrospective single‐center experience

Cited by 27 publications

References 29 publications

High mortality associated with gram-negative bacterial bloodstream infection in liver transplant recipients undergoing immunosuppression reduction

High mortality associated with gram-negative bacterial bloodstream infection in liver transplant recipients undergoing immunosuppression reduction

Evaluation of extensively drug-resistant gram-negative bacteremia among solid-organ transplant recipients: a multicenter study

Risk Factors for Acquisition of Carbapenem-Resistant Klebsiella pneumoniae and Mortality Among Abdominal Solid Organ Transplant Recipients with K. pneumoniae Infections

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