肾移植受者的社区获得性菌血症：受者在死亡率和肾损伤方面预后良好。

Community-onset bacteremia in kidney transplant recipients: The recipients fare well in terms of mortality and kidney injury.

机构信息

Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

出版信息

J Microbiol Immunol Infect. 2016 Oct;49(5):685-691. doi: 10.1016/j.jmii.2014.08.027. Epub 2014 Nov 1.

DOI:10.1016/j.jmii.2014.08.027

PMID:25442875

Abstract

BACKGROUND

Bloodstream infection is not uncommon in kidney transplant recipients (KTRs) and is associated with mortality, graft loss, and increased medical expenses. Whether these septic patients are more vulnerable to serious complications, resistant strains, or worse clinical outcomes than other patient groups in the community-onset settings remains undetermined.

METHODS

A retrospective study was conducted at a medical center in southern Taiwan. Community-onset bacteremia in the KTRs and a control population at the emergency department were identified. Demographic data, clinical characteristics, bacteremic pathogens, antimicrobial resistance, and clinical outcomes were recorded.

RESULTS

Forty-one bacteremic episodes in the KTRs and 82 episodes in control patients were studied. The KTR group had younger age, fewer malignancies, more urosepsis (61% vs. 22%, p = 0.004), and fewer biliary tract infections (0% vs. 13.4%, p = 0.018). Escherichia coli was the most commonly isolated pathogen in both the groups (51.2% and 41.5%, respectively). No Klebsiella pneumoniae bacteremia was noted in the KTRs, compared with 14 (17.1%) episodes in the control group (p = 0.010). Antimicrobial resistance profiles of bacteremic pathogens were similar (all p > 0.6). The KTRs with community-onset bacteremia did not have a worse outcome (in-hospital mortality rate: 2.4% vs. 10%, p = 0.172) nor more incomplete resolution of kidney injury after acute kidney injury events (21.1% vs. 25%, p > 0.99) than the control group.

CONCLUSION

KTRs with community-onset bacteremia did not fare worse in terms of clinical outcome and kidney injury.

摘要

背景

血源感染在肾移植受者（KTR）中并不罕见，与死亡率、移植物丢失和医疗费用增加有关。在社区获得性发病环境中，与其他患者群体相比，这些败血症患者是否更容易出现严重并发症、耐药菌株或更差的临床结局，目前仍未确定。

方法

本研究在台湾南部的一家医疗中心进行，对 KTR 和急诊科的社区获得性菌血症患者进行了回顾性研究。记录了人口统计学数据、临床特征、菌血症病原体、抗菌药物耐药性和临床结局。

结果

研究了 KTR 中的 41 例菌血症发作和对照组中的 82 例菌血症发作。KTR 组年龄较小，恶性肿瘤较少，尿脓毒症（61%比 22%，p=0.004）和胆道感染（0%比 13.4%，p=0.018）较少。两组最常见的分离病原体均为大肠杆菌（分别为 51.2%和 41.5%）。KTR 中未发现肺炎克雷伯菌血症，而对照组中有 14 例（17.1%）（p=0.010）。菌血症病原体的抗菌药物耐药谱相似（均 p>0.6）。与对照组相比，KTR 发生社区获得性菌血症后，其临床结局（院内死亡率：2.4%比 10%，p=0.172）和急性肾损伤事件后肾脏损伤不完全恢复的比例（21.1%比 25%，p>0.99）均无明显差异。