Bloodstream infection caused by enteric organisms during the first 6 months after intestinal transplant

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Abstract

Background: Data on bloodstream infection (BSI) due to enteric organisms are scarce. Methods: This retrospective study (1/2009-5/2017) was aimed to evaluate the incidence of BSI episodes due to enteric organisms during the first 6 months after intestinal transplant (ITx). Differences between the first (2009-2012) and second period (2013-2017) were evaluated as they differed from each other in the perioperative fungal prophylaxis and immunosuppressive regimen. Results: Fifty-five adult patients were analyzed. Twenty-eight (51%) patients developed a total of 51 episodes of BSI. Mean time from transplant to BSI was 85.5 ± 58.8 days. The most common organisms were Klebsiella pneumoniae (33%), Enterococcus spp (31%), and Candida spp (18%). Twenty-three (45%) were multidrug resistant. The most common sources were gut translocation (35%), central line infection (20%), and intra-abdominal abscess (14%). Biopsy-proven rejection was associated with 16 (31%) of the BSI episodes. Patients during the first period were more likely to develop BSI (79% vs 41%, P = 0.03). There were more episodes of rejection associated with BSI in the first period (45% vs 14%, P = 0.03). The rate of reoperation into the abdominal cavity within 2 weeks after ITx was higher and the transplant hospital stay was longer among those who developed BSI (P = 0.04 for both). Conclusions: Half of our patients developed BSI (typically during the first 3 months). Gut translocation was the most common source of BSI. Patients with rejection and/or enteritis should be monitored closely for BSI.

Original languageEnglish (US)
Article numbere13064
JournalTransplant Infectious Disease
DOIs
StatePublished - Jan 1 2019

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Transplants
Infection
Abdominal Abscess
Enteritis
Abdominal Cavity
Enterococcus
Klebsiella pneumoniae
Immunosuppressive Agents
Reoperation
Candida
Length of Stay
Retrospective Studies
Biopsy
Incidence

Keywords

  • bloodstream infection
  • enteric organisms
  • gut translocation
  • multidrug-resistant organisms
  • rejection

ASJC Scopus subject areas

  • Transplantation
  • Infectious Diseases

Cite this

@article{4a079968cd234fdeae7015d35eb0e987,
title = "Bloodstream infection caused by enteric organisms during the first 6 months after intestinal transplant",
abstract = "Background: Data on bloodstream infection (BSI) due to enteric organisms are scarce. Methods: This retrospective study (1/2009-5/2017) was aimed to evaluate the incidence of BSI episodes due to enteric organisms during the first 6 months after intestinal transplant (ITx). Differences between the first (2009-2012) and second period (2013-2017) were evaluated as they differed from each other in the perioperative fungal prophylaxis and immunosuppressive regimen. Results: Fifty-five adult patients were analyzed. Twenty-eight (51{\%}) patients developed a total of 51 episodes of BSI. Mean time from transplant to BSI was 85.5 ± 58.8 days. The most common organisms were Klebsiella pneumoniae (33{\%}), Enterococcus spp (31{\%}), and Candida spp (18{\%}). Twenty-three (45{\%}) were multidrug resistant. The most common sources were gut translocation (35{\%}), central line infection (20{\%}), and intra-abdominal abscess (14{\%}). Biopsy-proven rejection was associated with 16 (31{\%}) of the BSI episodes. Patients during the first period were more likely to develop BSI (79{\%} vs 41{\%}, P = 0.03). There were more episodes of rejection associated with BSI in the first period (45{\%} vs 14{\%}, P = 0.03). The rate of reoperation into the abdominal cavity within 2 weeks after ITx was higher and the transplant hospital stay was longer among those who developed BSI (P = 0.04 for both). Conclusions: Half of our patients developed BSI (typically during the first 3 months). Gut translocation was the most common source of BSI. Patients with rejection and/or enteritis should be monitored closely for BSI.",
keywords = "bloodstream infection, enteric organisms, gut translocation, multidrug-resistant organisms, rejection",
author = "Jacques Simkins and Morillas-Rodriguez, {Jose A.} and Morris, {Michele I.} and Abbo, {Lilian M.} and Camargo, {Jose F.} and Gennaro Selvaggi and Thiago Beduschi and Akin Tekin and Rodrigo Vianna",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/tid.13064",
language = "English (US)",
journal = "Transplant Infectious Disease",
issn = "1398-2273",
publisher = "Wiley-Blackwell",

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TY - JOUR

T1 - Bloodstream infection caused by enteric organisms during the first 6 months after intestinal transplant

AU - Simkins, Jacques

AU - Morillas-Rodriguez, Jose A.

AU - Morris, Michele I.

AU - Abbo, Lilian M.

AU - Camargo, Jose F.

AU - Selvaggi, Gennaro

AU - Beduschi, Thiago

AU - Tekin, Akin

AU - Vianna, Rodrigo

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Data on bloodstream infection (BSI) due to enteric organisms are scarce. Methods: This retrospective study (1/2009-5/2017) was aimed to evaluate the incidence of BSI episodes due to enteric organisms during the first 6 months after intestinal transplant (ITx). Differences between the first (2009-2012) and second period (2013-2017) were evaluated as they differed from each other in the perioperative fungal prophylaxis and immunosuppressive regimen. Results: Fifty-five adult patients were analyzed. Twenty-eight (51%) patients developed a total of 51 episodes of BSI. Mean time from transplant to BSI was 85.5 ± 58.8 days. The most common organisms were Klebsiella pneumoniae (33%), Enterococcus spp (31%), and Candida spp (18%). Twenty-three (45%) were multidrug resistant. The most common sources were gut translocation (35%), central line infection (20%), and intra-abdominal abscess (14%). Biopsy-proven rejection was associated with 16 (31%) of the BSI episodes. Patients during the first period were more likely to develop BSI (79% vs 41%, P = 0.03). There were more episodes of rejection associated with BSI in the first period (45% vs 14%, P = 0.03). The rate of reoperation into the abdominal cavity within 2 weeks after ITx was higher and the transplant hospital stay was longer among those who developed BSI (P = 0.04 for both). Conclusions: Half of our patients developed BSI (typically during the first 3 months). Gut translocation was the most common source of BSI. Patients with rejection and/or enteritis should be monitored closely for BSI.

AB - Background: Data on bloodstream infection (BSI) due to enteric organisms are scarce. Methods: This retrospective study (1/2009-5/2017) was aimed to evaluate the incidence of BSI episodes due to enteric organisms during the first 6 months after intestinal transplant (ITx). Differences between the first (2009-2012) and second period (2013-2017) were evaluated as they differed from each other in the perioperative fungal prophylaxis and immunosuppressive regimen. Results: Fifty-five adult patients were analyzed. Twenty-eight (51%) patients developed a total of 51 episodes of BSI. Mean time from transplant to BSI was 85.5 ± 58.8 days. The most common organisms were Klebsiella pneumoniae (33%), Enterococcus spp (31%), and Candida spp (18%). Twenty-three (45%) were multidrug resistant. The most common sources were gut translocation (35%), central line infection (20%), and intra-abdominal abscess (14%). Biopsy-proven rejection was associated with 16 (31%) of the BSI episodes. Patients during the first period were more likely to develop BSI (79% vs 41%, P = 0.03). There were more episodes of rejection associated with BSI in the first period (45% vs 14%, P = 0.03). The rate of reoperation into the abdominal cavity within 2 weeks after ITx was higher and the transplant hospital stay was longer among those who developed BSI (P = 0.04 for both). Conclusions: Half of our patients developed BSI (typically during the first 3 months). Gut translocation was the most common source of BSI. Patients with rejection and/or enteritis should be monitored closely for BSI.

KW - bloodstream infection

KW - enteric organisms

KW - gut translocation

KW - multidrug-resistant organisms

KW - rejection

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U2 - 10.1111/tid.13064

DO - 10.1111/tid.13064

M3 - Article

C2 - 30865328

AN - SCOPUS:85064952738

JO - Transplant Infectious Disease

JF - Transplant Infectious Disease

SN - 1398-2273

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