Epidemiology of Bloodstream Infections in Solid Organ Transplant Recipients
MetadataShow full item record
BACKGROUND: Infection represents one of the most common and serious complications following solid organ transplantation (SOT). In particular, bloodstream infections (BSIs) are associated with considerable morbidity and mortality in transplant patients. We sought to describe the epidemiology of BSI in SOT recipients at UTSW. METHODS: The design of the study was a retrospective single center cohort study. Innovative data mining tools were utilized to extract demographic, clinical and laboratory variables from the electronic medical record. All SOT were performed at UTSW between 1/1/2010 and 6/30/2015 were included in the study. The duration of follow-up was 1 year. BSI episodes were defined as positive cultures separated by ≥7 days. Positive cultures of the same organism in a patient <7 days apart counted as a single BSI episode. Positive cultures of different organisms in a patient <7 days apart counted as discrete BSI episodes for that particular organism. RESULTS: Of the 837 SOT patients transplanted during the study period, 60 patients experienced at least one episode of BSI (7%), with 49 patients having only one episode and 11 having multiple. In total, 78 episodes of BSI occurred among these patients, 43 due to gram-negatives (55.1%), 34 due to gram-positives (43.6%), and one due to Candida (1.3%). The most common microorganisms identified were S. epidermidis (15.38%), E. Coli (15.38%), Klebsiella sp. (12.82%), P. aeruginosa (12.82%), and Vancomycin-resistant E. faecium (11.54%). The cumulative incidence of BSI at 1 year post-transplant was 16.0%, 15.1%, 14.3%, 11.8% and 7.4% for simultaneous, heart, liver, lung and kidney transplant recipients, respectively. The timing of the first episode of BSI was as follows: twenty-one episodes (35%) occurred during the first month, 27 (45%) between 1 and 6 months and 12 (20%) after 6 months post-transplantation. The all-cause mortality in SOT recipients with at least one positive culture was greater than the SOT recipients with negative cultures. CONCLUSION: The cumulative incidence of BSI at 1-year post-transplantation for all organs was 11.8%. The highest BSI cumulative incidence occurred in simultaneous SOT recipients (16.0%), suggesting that they may be at a higher risk. Most of the episodes of BSI occurred > 1 month post-transplantation. The all-cause mortality in SOT recipients with at least one positive culture was greater than the SOT recipients with negative cultures. Further studies are required to identify independent risk and prognostic factors.