Bloodstream infections are common in patients who have received a solid organ transplants. Approximately half of such cases occur within the first 6 months post-transplant, and are associated with significant long- and short-term mortality, according to research presented at IDWeek 2019, held from October 2 to October 6, in Washington, DC.
This retrospective study surveyed bloodstream infections in recipients of 6 types of solid organ transplants over 9 years at a large university medical center, from January 2010 to January 2019. Single blood cultures that returned positive for infection with Propionibacterium, Bacillus, Corynebacterium, or coagulase-negative staphylococci were excluded. A total of 3358 patients who underwent solid organ transplantation were included: 1% were small bowel/multivisceral (n=43), 4% pancreas (n=149), 8% heart (n=256), 21% liver (n=700), 23% lung (n=778), and 43% kidney (n=1432).
There were 770 total cases of bloodstream infection: 16% of the cohort had at least 1 episode of bloodstream infection and 14% were recurrent cases. Rates of bloodstream infections were highest among patients who received a small bowel/multivisceral transplant (53%), followed by those who received transplantations of the lung (22%), liver (20%), pancreas (15%), and heart and kidney (14%, each). Further, 20% of bloodstream infections occurred within 30 days post-transplant, 24% between 31 and 180 days after, and 7% between 181 and 365 days after. The rates of bloodstream infections occurring up to and more than 180 days post-transplant were 3.6 and 0.65/1000 patient-days, respectively (P <.0001). The most common infecting bacteria were Enterobacteriaceae (35%) and Enterococcus spp (22%), whereas 6% of infections were as a result of Candida spp, and 8% of bloodstream infections were polymicrobial.
Between 2016 and 2018, 15% of Enterobacteriaceae infections were multi-drug resistant, 8% of which were extensively drug resistant. Further, 23% of infections with P aeruginosa extensively drug resistant. Thirty-day mortality after diagnosis of bloodstream infection was highest for patient who received heart transplants patients at 31%, followed by cases of lung transplantation at 15%, liver transplantation at 10%, pancreas transplantation at 9%, and small bowel/multivisceral transplantation at 4%.
Study investigators concluded, “Predominant [bloodstream infection] pathogens differ between [solid organ transplant] types; as such, empiric antimicrobial therapy decisions should be organ-specific [and] centers should use overall [solid organ transplant] and organ-specific antibiograms to drive empiric antimicrobial strategies.”
Buehrle D, Clancy CJ, Rivosecchi R, Clark L, Nguyen M-H. Nine-year survey of bloodstream infections (BSIs) across six types of solid organ transplant (SOT) at a large university medical center. Poster presented at: IDWeek 2019; October 2-6, 2019; Washington, DC. Abstract #226.