Singh R P, Farney A C, Rogers J, Ashcraft E, Hart L, Doares W, Hartmann E L, Reeves-Daniel A, Adams P L, Stratta R J
Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina 27157, USA.
Transplant Proc. 2008 Mar;40(2):506-9. doi: 10.1016/j.transproceed.2008.02.015.
The objective of this study was to review the incidence, risk factors, and impact of bacteremia after pancreas transplantation (PTX).
We performed a retrospective analysis of consecutive simultaneous kidney-pancreas transplantations (SKPTs) and solitary PTXs from January 2002 through April 2007. Positive blood cultures were correlated with other coexisting infections and parameters.
One hundred ten PTXs with enteric drainage included 80 SKPTs and 30 solitary PTXs. Mean follow-up was 32 months. Bacteremia occurred in 29 (26%) patients with 5 (17%) being recurrent; it was seen during the first month after transplantation in 13 (12%), between 1 and 3 months in 12 (11%), between 3 and 12 months in 3 (3%), and after the first year in 3 cases (3%). Typical organisms were as follows: MRSE, MSSE, Klebsiella, Escherichia coli, vancomycin-resistant enterococci (VRE), and Acinetobacteri. Bacteremia was associated with coexisting site infection in 20 cases (69%): deep abdominal wound (31%); line (31%); urinary tract (34%); and pulmonary (7%). Similar bacterial species in blood and a coexisting site occurred in 15 cases (52%). No correlation was seen with cytomegalovirus (CMV) infections. In the first year, bacteremia was associated with more acute rejection episodes (32% vs 17%; P = .09), surgical complications (54% vs 42%; P = .267), mortality (11% vs 4%; P = .15), and death-censored pancreatic (14% vs 9%; P = .39) and kidney (4% vs 0; P = .08) graft loss. Fewer patients with bacteremia received alemtuzumab compared with rATG induction (14% vs 39%; P = .04).
Bacteremias were common within 3 months of PTX. A significant number (39%) were multidrug resistant. The majority were accompanied by abdominal, urinary, or line infections. Bacteremias were associated with slightly higher incidences of rejection, mortality, and graft loss.
本研究的目的是回顾胰腺移植（PTX）后菌血症的发生率、危险因素及影响。
我们对2002年1月至2007年4月期间连续进行的同期肾胰腺移植（SKPT）和单独胰腺移植进行了回顾性分析。血培养阳性与其他并存感染及参数相关。
110例采用肠内引流的PTX包括80例SKPT和30例单独PTX。平均随访32个月。29例（26%）患者发生菌血症，其中5例（17%）复发；移植后第1个月内发生13例（12%），1至3个月发生12例（11%），3至12个月发生3例（3%），第1年后发生3例（3%）。典型病原体如下：耐甲氧西林表皮葡萄球菌、表皮葡萄球菌、克雷伯菌、大肠杆菌、耐万古霉素肠球菌（VRE）和不动杆菌。20例（69%）菌血症与并存部位感染相关：深部腹部伤口（31%）；导管（31%）；泌尿道（34%）；肺部（7%）。15例（52%）血中和并存部位存在相似细菌种类。未发现与巨细胞病毒（CMV）感染相关。在第1年，菌血症与更多急性排斥反应发作（32%对17%；P = 0.09）、手术并发症（54%对42%；P = 0.267）、死亡率（11%对4%；P = 0.15）以及死亡审查后的胰腺（14%对9%；P = 0.39）和肾脏（4%对0；P = 0.08）移植物丢失相关。与兔抗胸腺细胞球蛋白诱导相比，接受阿仑单抗诱导的菌血症患者较少（14%对39%；P = 0.04）。
PTX后3个月内菌血症常见。相当数量（39%）为多重耐药。大多数伴有腹部、泌尿道或导管感染。菌血症与排斥反应、死亡率和移植物丢失的发生率略高相关。
