Sodoma Andrej M, Pellegrini James R, Munshi Rezwan F, Greenberg Samuel, Rathi Sonika, Saggar Tulika, Sinha Atul, Desai Jiten, Mustacchia Paul
Department of Internal Medicine, South Shore University Hospital, Bay Shore, New York.
Gastroenterology Department, Nassau University Medical Center, East Meadow, New York.
Transplant Proc. 2025 May;57(4):670-674. doi: 10.1016/j.transproceed.2025.02.037. Epub 2025 Mar 17.
Liver transplant (LT) recipients have a profound susceptibility to infections. Although Nocardia and Actinomyces (NAs) are well-known bacteria that typically affect immunosuppressed patients, a scarcity of research exists on the effects of LT with NA infections. Our study aims to evaluate the outcomes associated with NA infections in patients with LT. Patients were selected from the National Inpatient Sample (NIS) from 2008 through 2020. International Classification of Disease revision 9 (ICD-9) and ICD revision 10 (ICD-10) codes. Patients admitted with a history of LT were subdivided into those who were and were not diagnosed with an NA infection. Records were weighted using the NIS algorithm. Primary outcomes were all-cause hospital mortality, acute kidney injury (AKI), acute myocardial infarction (AMI), shock, and a composite of these. Secondary outcomes were length of stay, total charges, cytomegalovirus (CMV), and transplant rejection. Demographics and comorbidities were compared between the groups with a weighted chi-square test. Outcomes were compared between the two groups, and adjusted odds ratios (ORs) and regression coefficients were calculated using weighted logistic or linear regression as appropriate. ORs were adjusted for age, gender, race, hospital characteristics, Charlson Comorbidity Index (CCI), median income based on zip code, weekend admission, and insurance. There were 469,141 patients with LT who were included in this study, 310 of them had NA infection (0.07%). Patients in each group were of similar age, race, and overall medical complexity (P > .05). Patients with NA infection were less likely to have a history of coronary artery disease (CAD; 4.84% vs 16.20%, P < .05), hypertension (14.53% vs 25.82%, P < .05), and obesity (1.61% vs 9.0%, P < .05) than the healthy controls. Patients with LT with NA infection were found to have higher odds of mortality (OR = 5.50, P < .001), AKI (OR = 1.9, P < .05), composite outcome (OR = 2.19, P < 0.01), and more likely to have CMV infection (OR = 6.38, P < .01). Patients with LT with NA infection stayed 13.11 days longer in the hospital (P < .01) with charges of $60,399 more (P < .01) than the healthy controls. Patients with LT who acquired an NA infection were at nearly six-fold higher odds of death and other negative outcomes. Based on previous research that has demonstrated organ transplant patients to be at high risk of infections, more vigilant care should be taken to protect patients with LT from such opportunistic infections.
肝移植（LT）受者极易感染。尽管诺卡菌属和放线菌属（NAs）是众所周知的通常会影响免疫抑制患者的细菌，但关于LT合并NA感染影响的研究却很少。我们的研究旨在评估LT患者中与NA感染相关的结局。患者选自2008年至2020年的全国住院患者样本（NIS）。使用国际疾病分类第9版（ICD - 9）和第10版（ICD - 10）编码。有LT病史的入院患者被细分为诊断出和未诊断出NA感染的患者。记录使用NIS算法进行加权。主要结局是全因住院死亡率、急性肾损伤（AKI）、急性心肌梗死（AMI）、休克以及这些情况的综合。次要结局是住院时间、总费用、巨细胞病毒（CMV）和移植排斥反应。使用加权卡方检验比较两组之间的人口统计学和合并症情况。比较两组之间的结局，并根据情况使用加权逻辑回归或线性回归计算调整后的优势比（ORs）和回归系数。ORs针对年龄、性别、种族、医院特征、查尔森合并症指数（CCI）、基于邮政编码的中位数收入、周末入院情况和保险进行了调整。本研究纳入了469141例LT患者，其中310例有NA感染（0.07%）。每组患者在年龄、种族和总体医疗复杂性方面相似（P > 0.05）。与健康对照组相比，有NA感染的患者患冠状动脉疾病（CAD）的病史可能性更低（4.84%对16.20%，P < 0.05）、高血压（14.53%对25.82%，P < 0.05）和肥胖（1.61%对9.0%，P < 0.05）。发现LT合并NA感染的患者死亡率更高（OR = 5.50，P < 0.001）、发生AKI的可能性更高（OR = 1.9，P < 0.05）、综合结局的可能性更高（OR = 2.19，P < 0.01），并且更有可能发生CMV感染（OR = 6.38，P < 0.01）。LT合并NA感染的患者住院时间比健康对照组长13.11天（P < 0.01），费用高出60399美元（P < 0.01）。发生NA感染的LT患者死亡和出现其他不良结局的几率几乎高出六倍。基于先前已证明器官移植患者感染风险高的研究，应更加警惕地采取措施保护LT患者免受此类机会性感染。
