Department of Pediatrics, University of Michigan, Ann Arbor, MI.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.
Transplantation. 2023 Aug 1;107(8):1820-1827. doi: 10.1097/TP.0000000000004590. Epub 2023 Mar 24.
Solid organ transplant recipients are at high risk for Staphylococcus aureus bacteremia, but the risks before and after transplantation require further research.
We performed a population-based retrospective self-controlled study using the State Inpatient Database from 10 states in the United States. Adult and pediatric patients who had solid organ transplantation from 2004 to 2018 were tracked longitudinally for 1 y before and after transplantation outside of the immediate peritransplant periods. The exposure of interest was solid organ transplantation, and the outcome of interest was hospitalization with S. aureus bacteremia.
Of 75 549 patients, 581 (0.77%) and 239 (0.32%) were hospitalized with S. aureus bacteremia in the pretransplant and posttransplant periods, respectively ( P < 0.001). Overall, the odds of hospitalization with S. aureus bacteremia increased from 7 to 12 mo to 1 to 6 mo before transplantation (odds ratio, 1.24; 95% confidence interval, 1.05-1.46) and then decreased following transplantation (odds ratio, 0.35; 95% confidence interval, 0.28-0.45; 7-12 mo after transplantation). The decreased rate after transplantation was driven by the cases associated with central line-associated bloodstream infections and endocarditis among kidney and heart transplant recipients. Odds of hospitalization with S. aureus bacteremia did not change after liver transplantation, whereas they increased after lung transplantation.
In addition to immunosuppression, the reversal of organ failure and associated requirements for organ support following transplantation may play an important role in the risk of S. aureus bacteremia in solid organ transplant recipients. These results can guide infection prevention approaches and future research on S. aureus infections in transplant patients.
实体器官移植受者发生金黄色葡萄球菌菌血症的风险很高，但移植前后的风险仍需要进一步研究。
我们在美国 10 个州的州际住院患者数据库中开展了一项基于人群的回顾性自身对照研究。我们对 2004 年至 2018 年期间进行实体器官移植的成年和儿科患者进行了纵向跟踪，在移植前后 1 年内不包括移植围手术期。研究的暴露因素是实体器官移植，研究的结局是金黄色葡萄球菌菌血症所致住院。
在 75549 例患者中，分别有 581 例（0.77%）和 239 例（0.32%）在移植前和移植后期间因金黄色葡萄球菌菌血症住院（P<0.001）。总体而言，在移植前 7 至 12 个月和 1 至 6 个月时，金黄色葡萄球菌菌血症住院的可能性从 7 增加到 12 个月（比值比，1.24；95%置信区间，1.051.46），随后在移植后降低（比值比，0.35；95%置信区间，0.280.45；移植后 7 至 12 个月）。移植后下降率是由与肾和心脏移植受者中心静脉相关血流感染和心内膜炎相关的病例驱动的。肝移植后金黄色葡萄球菌菌血症住院的可能性没有变化，而肺移植后则增加。
除免疫抑制外，器官衰竭的逆转以及移植后对器官支持的需求可能在实体器官移植受者金黄色葡萄球菌菌血症的风险中发挥重要作用。这些结果可以指导感染预防措施，并为移植患者金黄色葡萄球菌感染的未来研究提供信息。
