Solid Organ Transplantation & Data Mining: Bloodstream Infections Have a Significant Impact on One-Year Survival and qSOFA ≥ 2 Predicts 3-Day Mortality

BACKGROUND: We created a retrospective and prospective database of SOT recipients using innovative data mining tools. This study describing the epidemiology of BSI in SOT serves as a proof of concept of such techniques in clinical research. METHODS: The design of the study was a retrospective single center cohort study. Data mining tools were used to extract information from the electronic medical record and merged it with data from the Scientific Registry of Transplant Recipients (SRTR) national database. First SOT from 1/1/2010-12/31/2015 were included. Charts of subjects with positive blood cultures were manually reviewed and adjudicated using CDC/NHSN and SCCM/ESICM criteria. The 1-year cumulative incidence was calculated using the Kaplan-Meier method. Cox proportional hazards models were used to identify risk factors for BSI and 1 year mortality. BSI was analyzed as a time-dependent covariate in the mortality model. Fisher's exact test and Chi-Square were used to identify risk factors for 30-day mortality and multidrug resistant organisms (MDRO). RESULTS: 917 SOT recipients met inclusion criteria. 75 patients experienced at least one BSI. The cumulative incidence was 8.4% (95% CI 6.8-10.4). The onset of the 1st BSI episode was: 30 episodes (40%) < 1 month, 33 (44%) 1-6 months and 12 (16%) > 6 months. The most common pathogens were Klebsiella sp. (16%), Vancomycin-resistant E. faecium (12%), E. Coli (12%), CoNS (12%), and Candida sp. (9.3%). Nineteen isolates (25%) were identified as MDRO; the risk of MDRO was highest < 1 month compared to 1-6 and > 6 months (44.8 vs. 12.1 vs. 16.7 p=0.01). The most common source of BSI was CLABSI (29%). In multivariable analysis the risk of BSI was associated with organ type (HR [95%CI] = Multiorgan 3.5 [1.1-11.6], liver 2.5 [1.1-5.4], heart 2.4 [1.1-5.1]) and acquisition of a BSI was associated with a higher 1-year mortality (HR=8.7 [5.1- 14.7]). In univariable analysis, a polymicrobial BSI (14.7 vs. 57.1% p=0.02), qSOFA ≥ 2 (0.0 vs. 25.5% p=0.02) and septic shock (3.9 vs. 52.2% p<0.001) were associated with an increased risk of death at 30 days. CONCLUSION: A BSI significantly impacts the 1-year survival of SOT recipients. A qSOFA ≥ 2 can be used at the bedside to identify patients at increased risk for death. Additionally this study illustrates the potential of data mining tools to study infectious complications.