Epidemiology, risk factors, and impact of bacterial infections on outcomes for pancreatic grafts

Abstract

We aimed to determine the epidemiology, risk factors, and impact of bacterial infection on pancreatic function after pancreas transplantation. Data for pancreas transplant recipients were retrospectively reviewed between 2000 and 2014 for at least 1 year. We collected and analyzed post-transplant data for bacterial infection, morbidity, and mortality. During the study period, 312 pancreas transplants were performed. In total, 509 episodes of bacterial infection were diagnosed in 191 patients (61%). Multidrug-resistant (MDR) organisms were present in 173 of the 513 isolated microorganisms (33%). Risk factors independently associated with bacterial infection were acute allograft rejection (OR 1.7, 95%CI 1.1-3), the need for post-transplant hemodialysis, (OR 5.3, 95%CI 1.8-15.7) and surgical re-intervention (OR 2.8, 95%CI 1.5-5.1), which was also considered a risk factor for infections caused by MDR bacteria. Graft survival was associated with the occurrence of one or more episodes of bacterial infection (log-rank test = 0.009). Surgical re-intervention was independently associated with graft loss (OR 2.5, 95%CI 1.3-4.7). To conclude, pancreas recipients frequently experienced bacterial infections associated with the need for hemodialysis or surgical re-intervention. Infection by MDR organisms is a growing concern in these patients and was related to graft survival. Graft loss was independently associated with surgical re-intervention.

Origin and Clinical Impact of Early Multidrug-Resistant (MDR) Contamination in Patients Undergoing Pancreaticoduodenectomy

“…Our study confirmed that MDR infections worsened the outcome of patients undergoing pancreaticoduodenectomy, specifically in clinically relevant postoperative pancreatic fistula, wound infections, and the reintervention rate. The last finding aligns with a study by Bodro et al [23], which demonstrated that surgical re-operation after pancreas transplantation was independently associated with the development of infections by MDR organisms. Also, the length of stay, as reported in other studies [24,25], is deeply affected by the presence of MDR bacteria.…”

Origin and Clinical Impact of Early Multidrug Resistant (MDR) Contamination in Patients Undergoing Pancreaticoduodenectomy

“…Our study confirmed that MDR infections worsened the outcome of patients undergoing pancreaticoduodenectomy, specifically in clinically relevant postoperative pancreatic fistula, wound infections, and reintervention rate. The last finding aligns with a study by Bodro et al [23], which demonstrated that surgical re-intervention after pancreas transplantation was independently associated with the development of infections by MDR organisms. Also, the length of stay, as reported in other studies [24,25], is deeply affected by the presence of an MDR bacteria.…”

Acute murine cytomegalovirus disrupts established transplantation tolerance and causes recipient allo-sensitization

“…Using a murine model of CMV infection, we have previously reported that acute MCMV infection abrogates the induction of transplantation tolerance by priming alloreactive CD8 T cells through altering myeloid‐derived suppressor cell (MDSC) differentiation and promoting their maturation to inflammatory monocytes capable of cross‐presentation 8 . Clinically, numerous other bacterial and viral infections have also been known to correlate with allograft rejection 9‐13 via additional mechanisms including activation of alloreactive T and B cell responses 14‐17 …”