Survival Outcome of Sepsis in Recipients of Solid Organ Transplant

Abstract

Sepsis is a complex disease stemming from a dysregulated immune response toward an infectious agent. In transplantation, sepsis remains one of the leading causes of morbidity and mortality. Solid organ transplant recipients have impaired adaptive immunity due to immunosuppression required to prevent rejection. Immunosuppression has unintended consequences, such as increasing the risk of infections and sepsis. Due to its high morbidity and mortality, early detection of sepsis is paramount to start aggressive treatment. Several biomarkers or combination of biomarkers of sepsis have emerged in the last decade, but they are not dependable for early diagnosis or for outcome prognosis.

Gram‐negative bacteremia in solid organ transplant recipients: Clinical characteristics and outcomes as compared to immunocompetent non‐transplant recipients

“…It is often assumed that SOT recipients experience worse outcomes from BSI due to their immunosuppression. 12 However, we 13,14 and others [15][16][17] recently provided evidence to the contrary. In a small pilot matched prospective cohort study comparing SOT and immunocompetent, non-SOT recipients with Staphylococcus aureus, Escherichia coli, or Klebsiella pneumoniae bacteremia, we found that mortality did not significantly differ by transplant status.…”

“…The clinical characteristics contributing to the outcome of SOT recipients who develop Gram‐negative bacteremia (GNB), however, are incompletely understood. It is often assumed that SOT recipients experience worse outcomes from BSI due to their immunosuppression 12 . However, we 13,14 and others 15–17 recently provided evidence to the contrary.…”

“…Second, we found an inverse association between the level of immunosuppression and risk of septic shock and respiratory failure among SOT recipients with GNB. Immunosuppression management varies substantially, with some clinicians maintaining immunosuppression levels throughout the course of bacteremia 16,26–30 and others reducing immunosuppression levels despite definitive evidence to support this practice 12 . This variation in practice suggests that the clinical community is in equipoise and could benefit from a randomized controlled trial to establish best practices.…”

Incidence, risk factors and clinical outcome of multidrug-resistant organisms after heart transplantation

“…In the ICU, bacteremia arising from vascular catheter colonization is an important cause of patient destabilization[ 35 ]. MDRO bacteremia, in particular, is a recognized cause of sepsis in the ICU[ 36 , 37 ].…”

Association between blood culture turnaround time and clinical prognosis in emergency department patients with community acquired bloodstream infection: A retrospective study based on electronic medical records

“…Comorbidity is defined as the disease or status that may affect the prognosis of septic patient, such as cancer, autoimmune disease, chronic kidney disease, chronic liver disease, coronary artery disease, diabetes mellitus, hypertension, hyperlipidemia and history of organ transplantation [ 12 , 13 ].¸ [ [14] , [15] , [16] , [17] , [18] , [19] ]. The past medical history is confirmed by corresponding ICD coding ever documented in electronic medical records within the past year before hospital admission.…”