Division of Infectious Diseases and Travel Medicine, Department of Medicine, Georgetown University Medical Center, Washington, DC, USA.
Department of Medicine, Georgetown University Medical Center, Washington, DC, USA.
Transpl Infect Dis. 2021 Aug;23(4):e13668. doi: 10.1111/tid.13668. Epub 2021 Jul 8.
To examine the etiologies, risk factors, and microbiology of bloodstream infections (BSIs) among intestinal and multivisceral transplant recipients in the 2-year post-operative period.
A retrospective medical record review of adult intestinal or multivisceral transplant recipients between 2003 and 2015. Descriptive statistics were used to describe cohort data. Logistic regression was used to assess factors related to BSIs using a backward selection process.
One-hundred and six intestinal or multivisceral transplants were performed in 103 individuals. Fifty-eight percent (n = 62) developed a BSI in the 2-year post-operative period with a median time to first BSI of 53 days (interquartile range [IQR] 15, 169). The majority of BSIs were catheter related 38% (n = 58) when the source was known. Common microbiological isolates included enterococcus 20% (n = 36/174), coagulase-negative staphylococcus 14% (n = 23), and 12% Klebsiella spp (n = 21). Forty-seven percent (n = 17) of the enterococci were resistant to vancomycin, and 14% (n = 10/70) of the gram negatives were extended spectrum beta-lactamase (ESBL) producers. In adjusted analyses, (OR: 0.200 95% CI: 0.2, 0.514, P = .009) men were less likely to have a BSI. Transplant recipient age, allograft type, comorbidities, rejection, and length of stay were not noted to be risk factors for development of BSIs in our cohort. Mortality at 2-years post-transplant was similar for those who did not develop a BSI and those that developed infection, P = .5028.
BSIs are a common complication of intestinal transplantation, and central venous catheters were a common source. Interventions such as early catheter removal should be implemented to prevent infections in this population. Female sex association with BSI requires further investigation.
研究肠和多器官联合移植受者术后 2 年内血流感染（BSI）的病因、危险因素和微生物学。
对 2003 年至 2015 年间的成人肠或多器官联合移植受者进行回顾性病历回顾。采用描述性统计方法描述队列数据。采用向后选择法的 logistic 回归分析评估与 BSI 相关的因素。
103 名患者共进行了 106 例肠或多器官联合移植。58%（n=62）在术后 2 年内发生 BSI，首次 BSI 的中位时间为 53 天（四分位距[IQR]15，169）。当来源已知时，大多数 BSI 与导管有关，占 38%（n=58）。常见的微生物分离株包括肠球菌 20%（n=36/174）、凝固酶阴性葡萄球菌 14%（n=23）和 12%克雷伯氏菌属（n=21）。47%（n=17）的肠球菌对万古霉素耐药，14%（n=10/70）的革兰氏阴性菌为产Extended-spectrum beta-lactamase（ESBL）。在调整后的分析中，（OR：0.200 95%CI：0.2，0.514，P=0.009）男性发生 BSI 的可能性较低。在我们的队列中，移植受者年龄、同种异体移植物类型、合并症、排斥反应和住院时间均未被认为是 BSI 发生的危险因素。未发生 BSI 与发生感染的受者在移植后 2 年的死亡率相似，P=0.5028。
BSI 是肠移植的常见并发症，中心静脉导管是常见的感染源。应采取早期导管拔除等干预措施，预防该人群感染。BSI 与女性的相关性需要进一步研究。
