Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA.
Department of Surgery, Division of Abdominal Transplant Surgery, Duke University, Durham, North Carolina, USA.
Am J Transplant. 2022 Dec;22(12):3021-3030. doi: 10.1111/ajt.17189. Epub 2022 Sep 19.
Surgical site infections (SSI) are severe complications of solid organ transplant (SOT). This retrospective study assessed the epidemiology of and outcomes associated with invasive primary SSI (IP-SSI) occurring within 3 months of transplantation in adult SOT recipients at Duke University over a 5-year period (2015-2019). Among 2073 consecutive SOT recipients, 198 IP-SSI were identified. The IP-SSI rate declined over the period (14.4% in 2015 vs. 8.3% in 2019) and was higher among multi-organ compared with single-organ transplants (33.9% vs. 8.1%, p < .01). SOT recipients with IP-SSI had longer hospital stays than patients without SSI (30.0 vs. 17.0 days, p < .01). Transplant hospitalization (9.6% vs. 2.2%, p < .01), 6-month (11.6% vs. 3.3%, p < .01), and 1-year mortality (15.7% vs. 5.8%, p < .01) were higher in SOT recipients with IP-SSI than in those without. While Gram-positive bacteria were the most common pathogens, urogenital Mollicute and atypical Mycobacteria were identified as an unexpected cause of IP-SSI, particularly among lung transplant recipients. The median time to IP-SSI was 24.0 (IQR 13.8-48.3) days, although the time to IP-SSI varied based on organ transplanted and the causative pathogen. IP-SSI is an important and potentially modifiable complication of SOT, associated with prolonged hospitalizations and reduced survival, particularly in the lung transplant population.
手术部位感染（SSI）是实体器官移植（SOT）的严重并发症。这项回顾性研究评估了在过去 5 年（2015-2019 年）期间，杜克大学接受成人 SOT 的患者中，在移植后 3 个月内发生的原发性侵袭性 SSI（IP-SSI）的流行病学和相关结局。在 2073 例连续接受 SOT 的患者中，发现 198 例 IP-SSI。在此期间，IP-SSI 发生率下降（2015 年为 14.4%，2019 年为 8.3%），且多器官移植患者的发生率高于单器官移植患者（33.9%比 8.1%，p<0.01）。与无 SSI 的患者相比，发生 IP-SSI 的 SOT 患者的住院时间更长（30.0 天比 17.0 天，p<0.01）。移植住院（9.6%比 2.2%，p<0.01）、6 个月（11.6%比 3.3%，p<0.01）和 1 年死亡率（15.7%比 5.8%，p<0.01）均更高。革兰氏阳性菌是最常见的病原体，但泌尿生殖道莫拉菌和非典型分枝杆菌被鉴定为 IP-SSI 的意外原因，尤其是在肺移植患者中。IP-SSI 的中位时间为 24.0（IQR 13.8-48.3）天，尽管 IP-SSI 的时间因移植器官和病原体而异。IP-SSI 是 SOT 的一个重要且潜在可改变的并发症，与住院时间延长和生存率降低有关，尤其是在肺移植患者中。
