Infectious Diseases Section, University of Nebraska Medical Center, Omaha, NE 68198-5400, USA.
Pediatr Infect Dis J. 2012 Jan;31(1):25-9. doi: 10.1097/INF.0b013e3182310fb6.
No studies have evaluated the risk factors and outcomes of Staphylococcus aureus (SA) infections in small bowel (SBT) and multivisceral (including small bowel) transplantation (MVT).
SBT and MVT recipients with SA infections (22 cases) were retrospectively identified and compared with matched non-SA-infected recipient controls (44). The characteristics were compared with Friedman and Cochran-Mantel-Haenszel tests. Conditional logistic regression analysis was performed to identify risk factors, and Kaplan-Meier curve and Cox proportional hazard model were performed for survival analysis.
The median age was 2.07 years (range, 0.76-54.04). Forty-three percent of the first SA infections were bloodstream infections, 30% lung infections, and 26% surgical site infections; 36% of these isolates were methicillin-resistant SA. Median time (days) to surgical site infections (41.0; range, 0-89) was significantly shorter than that to lung infections (266; range, 130-378) (P = 0.01). By univariate analysis, it was found that cases were more likely to have cytomegalovirus (CMV) sero-mismatch (odds ratio [OR] = 3.03 [95% confidence interval, 0.88-10.43]; P = 0.08), and controls were more likely to receive mycophenolate mofetil (MMF) treatment (0.09 [0.001-0.82]; P = 0.03). By multivariable analysis, patients with CMV sero-mismatch were found to have higher odds of developing SA infection (OR, 2.92; P = 0.085), whereas MMF had a protective effect (OR, 0.08; P = 0.031), adjusting for matched criteria. SA cases had shorter survival than controls (mean survival, 28.5 vs. 45.8 months [P = 0.04]) and were 2.18 times more likely to die (1.02-4.67, P = 0.04).
SA infections were associated with a significant shorter survival time and higher risk of death. The presence of CMV sero-mismatch and the absence of MMF treatment were found to be the risk factors for SA infections after SBT and MVT.
目前尚无研究评估小肠（SBT）和多脏器（包括小肠）移植（MVT）中金黄色葡萄球菌（SA）感染的危险因素和结果。
回顾性确定了 22 例 SBT 和 MVT 受者 SA 感染（SA 感染组），并与 44 例匹配的非 SA 感染受者对照（非 SA 感染组）进行比较。采用 Friedman 和 Cochran-Mantel-Haenszel 检验比较特征。采用条件 logistic 回归分析确定危险因素，并采用 Kaplan-Meier 曲线和 Cox 比例风险模型进行生存分析。
中位年龄为 2.07 岁（范围，0.76-54.04）。43%的首次 SA 感染为血流感染，30%为肺部感染，26%为手术部位感染；这些分离株中 36%为耐甲氧西林的 SA。手术部位感染的中位时间（天）（41.0；范围，0-89）明显短于肺部感染（266；范围，130-378）（P=0.01）。单因素分析发现，病例组更可能存在巨细胞病毒（CMV）血清学不匹配（比值比[OR]，3.03[95%置信区间，0.88-10.43]；P=0.08），而对照组更可能接受吗替麦考酚酯（MMF）治疗（0.09[0.001-0.82]；P=0.03）。多变量分析发现，CMV 血清学不匹配的患者发生 SA 感染的可能性更高（OR，2.92；P=0.085），而 MMF 具有保护作用（OR，0.08；P=0.031），调整了匹配标准。SA 病例的生存时间短于对照组（平均生存时间，28.5 个月与 45.8 个月[P=0.04]），死亡风险高 2.18 倍（1.02-4.67，P=0.04）。
SA 感染与生存时间显著缩短和死亡风险增加有关。SBT 和 MVT 后，CMV 血清学不匹配的存在和 MMF 治疗的缺失被发现是 SA 感染的危险因素。
