Bige N, Zafrani L, Lambert J, Peraldi M-N, Snanoudj R, Reuter D, Legendre C, Chevret S, Lemiale V, Schlemmer B, Azoulay E, Canet E
Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France.
Transpl Infect Dis. 2014 Aug;16(4):588-96. doi: 10.1111/tid.12249. Epub 2014 Jun 26.
Kidney transplant recipients are at risk for life-threatening infections, which may affect the long-term prognosis.
We retrospectively included all kidney transplant recipients admitted for sepsis, severe sepsis, or septic shock to the medical intensive care unit (ICU) of the Saint-Louis Hospital, Paris, France, between 2000 and 2010. The main objective was to identify factors associated with survival without graft impairment 90 days after ICU discharge.
Data were available for 83 of 100 eligible patients. The main sites of infection were the lungs (54%), urinary tract (24%), and bloodstream (22%). Among documented infections (55/83), 80% were bacterial. Fungal infections were more common among patients transplanted after 2005 (5% vs. 23%, P = 0.02). Mechanical ventilation was used in 46 (56%) patients, vasopressors in 39 (47%), and renal replacement therapy (RRT) in 34 (41%). In-hospital and day-90 mortality rates were 20% and 22%, respectively. On day 90, among the 65 survivors, 39 (47%) had recovered their previous graft function and 26 (31%) had impaired graft function, including 16 (19%) who were dependent on RRT. Factors independently associated with day-90 survival and graft function recovery were baseline serum creatinine (odds ratio [OR] for a 10 μmol/L increase 0.94, 95% confidence interval [CI] 0.88-1.00) and cyclosporine therapy (OR 0.30, 95% CI 0.11-0.79).
Sepsis was chiefly related to bacterial pneumonia or urinary tract infection. Pneumocystis jirovecii was the leading opportunistic agent, with a trend toward an increase over time. Infections often induced severe graft function impairment. Baseline creatinine and cyclosporine therapy independently predicted the outcome.
肾移植受者面临危及生命的感染风险，这可能影响长期预后。
我们回顾性纳入了2000年至2010年间入住法国巴黎圣路易医院医学重症监护病房（ICU）的所有因脓毒症、严重脓毒症或脓毒性休克入院的肾移植受者。主要目标是确定与ICU出院后90天内无移植物损害存活相关的因素。
100名符合条件的患者中有83名的数据可用。主要感染部位为肺部（54%）、泌尿系统（24%）和血流（22%）。在有记录的感染中（55/83），80%为细菌感染。2005年后移植的患者中真菌感染更为常见（5%对23%，P = 0.02）。46名（56%）患者使用了机械通气，39名（47%）使用了血管升压药，34名（41%）使用了肾脏替代治疗（RRT）。住院死亡率和90天死亡率分别为20%和22%。在第90天，65名幸存者中，39名（47%）恢复了先前的移植物功能，26名（31%）移植物功能受损，其中16名（19%）依赖RRT。与第90天存活和移植物功能恢复独立相关的因素是基线血清肌酐（每增加10 μmol/L的比值比[OR]为0.94，95%置信区间[CI]为0.88 - 1.00）和环孢素治疗（OR 0.30，95% CI 0.11 - 0.79）。
脓毒症主要与细菌性肺炎或尿路感染有关。耶氏肺孢子菌是主要的机会性病原体，且有随时间增加的趋势。感染常导致严重的移植物功能损害。基线肌酐和环孢素治疗可独立预测预后。
