Bartoletti Michele, Vandi Giacomo, Furii Francesca, Bertuzzo Valentina, Ambretti Simone, Tedeschi Sara, Pascale Renato, Cristini Francesco, Campoli Caterina, Morelli Maria Cristina, Cescon Matteo, Pinna Antonio Daniele, Viale Pierluigi, Giannella Maddalena
Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Multivsceral transplant Unit, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Transpl Infect Dis. 2018 Oct;20(5):e12930. doi: 10.1111/tid.12930. Epub 2018 Jun 13.
Data about the optimal management of immunosuppressive therapy in liver transplant (LT) recipients with bloodstream infection (BSI) are missing. We aimed to describe the management of immunosuppressive therapy at diagnosis of BSI in LT recipients and to assess its impact on 28-day mortality.
We performed a single-center retrospective study of all LT recipients diagnosed with BSI, over 10-year period. Multivariate Cox regression analysis of risk factors for all cause 28-day mortality was adjusted for the propensity score of being managed with "any reduction" in immunosuppressive therapy at the diagnosis of BSI.
We identified 209 episodes of BSI in 157 LT recipients: 107 (68%) male, median age 54 (IQR 48-63) years. "Any reduction" was made in 90 (43%) cases including: dosage reduction of ≥1 immunosuppressive drug in 31 (15%), discontinuation of ≥1 immunosuppressive drug in 28 (13%), both dosage reduction and discontinuation in 13 (6%), complete withdrawal of immunosuppressive therapy in 18 (9%) cases. All-cause 28-day mortality rate was 13.4%, varying from 22% to 7% (P = .002) in cases with and without "any reduction". Cox regression showed septic shock (aHR 3.15, P = .007) and "any reduction" (aHR 2.50, P = .02) as independent risk factors for all-cause 28-day mortality, while Escherichia coli (aHR 0.38, P = .03) and source control (aHR 0.43, P = .04) were protective factors. The final model did not change after the introduction of the propensity score for "any reduction".
Any reduction in the immunosuppressive therapy was common and was associated with worse outcome in LT recipients developing BSI.
关于肝移植（LT）受者发生血流感染（BSI）时免疫抑制治疗的最佳管理的数据缺失。我们旨在描述LT受者诊断为BSI时免疫抑制治疗的管理情况，并评估其对28天死亡率的影响。
我们对10年间所有诊断为BSI的LT受者进行了一项单中心回顾性研究。对所有原因导致的28天死亡率的危险因素进行多变量Cox回归分析，并根据BSI诊断时接受免疫抑制治疗“任何减量”管理的倾向评分进行调整。
我们在157例LT受者中识别出209次BSI发作：107例（68%）为男性，中位年龄54岁（四分位间距48 - 63岁）。90例（43%）进行了“任何减量”，包括：≥1种免疫抑制药物剂量减少31例（15%），≥1种免疫抑制药物停用28例（13%），剂量减少和停用两者均有的13例（6%），免疫抑制治疗完全停用18例（9%）。全因28天死亡率为13.4%，在有和没有“任何减量”的病例中分别为22%至7%（P = 0.002）。Cox回归显示感染性休克（调整后风险比[aHR] 3.15，P = 0.007）和“任何减量”（aHR 2.50，P = 0.02）是全因28天死亡率的独立危险因素，而大肠杆菌感染（aHR 0.38，P = 0.03）和源头控制（aHR 0.43，P = 0.04）是保护因素。引入“任何减量”的倾向评分后，最终模型未改变。
免疫抑制治疗的任何减量都很常见，并且与发生BSI的LT受者的更差预后相关。
