Clinical and epidemiological differences and risk factors for death among solid organ transplant recipients with Gram-positive and Gram-negative bloodstream infections

Thiago Zinsly Sampaio Camargo,A R Marra,L F A Camargo,M Silva Jr

doi:10.1186/s40886-015-0007-0

Thiago Zinsly Sampaio Camargo, A R Marra + Show 2 more

Open Access

https://doi.org/10.1186/s40886-015-0007-0

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Abstract

Describe clinical and epidemiological differences and risk factors for death among Bloodstream Infections (BSI) caused by Gram Negative (GN) and Gram Positive (GP) bacteria in the setting of solid organ transplantation. We performed a retrospective analysis of medical records, which were evaluated patients undergoing solid organ transplantation with BSI in the period from January 2000 to January 31, 2006 at Hospital Sao Paulo and Hospital do Rim e Hipertensao (Universidade Federal de Sao Paulo, Brazil). It was also performed the analysis of risk factors for death. 195 patients were included in this study with a mean age of 43.3 (± 0.90) years, 114 (58.5 %) were male and, 81 (41.5 %) were female. 168 (86.2 %) were kidney transplants, 16 (8.2 %) kidney-pancreas, 5 (2.6 %) heart, 5 (2.6 %) liver and 1 (0.5 %) liver-kidney. The mean hospital stay was 34.2 (± 62.7) days. GN accounted for 147 (75.4 %) of the BSI episodes, whereas 48 (24.6 %) were caused by GP. In the group with BSI by GN the most common site of infection was the urinary tract in 68 (46.3 %) cases, and in the group with BSI by GP the most common was the primary source in 14 (29.1%) of the cases. The overall mortality of patients with BSI by GN was 19.7 % (29 cases) and by GP was 35.4 % (17 cases) (p = 0.03). In multiple logistic regression analysis, the variables associated independently with death in patients with BSI by GN were those who developed respiratory failure requiring mechanical ventilation Odds Ratio (OR) 13,2 95 % Confidence Interval (CI) = 3.07–57.19 (p = 0.001), beyond those which had number equal to or greater than two comorbidities OR 12.4 95 % CI = 1.90–80.35 (p = 0.008). In the population with BSI by GP only the respiratory failure requiring mechanical ventilation OR 28.3 CI 95=2.53–317.1 (p = 0.007) was independently associated with death. Patients with BSI showed the urinary source as the main site of infection. Death within 30 days occurred in 29 (19.7 %) patients with GN and 7 (35.4 %) patients with GP BSI (p = 0.03). Respiratory failure was a risk factor for death in patients with BSI by GN and GP.

Highlights

Transplantation is the treatment of choice for many patients with end-stage organ failure from a variety of causes resulting in prolonged survival and better quality of life for patients [1, 2]
Little is known about the differences between bacteremia from gram-negative and gram-positive bacteria in the setting of solid organ transplantation and their specific impact on mortality
The study was conducted at Hospital São Paulo and Hospital do Rim e Hipertensão, both affiliated to the Federal University of Sao Paulo, Brazil, and assessed a retrospective cohort of solid organ transplant recipients with bloodstream infections (BSIs) in the period from 1 January 2000 to 31 January 2006

Summary

Introduction

Among the infectious complications of solid organ transplantation, bacteremia is a major cause of mortality [3]. Aerobic gram-positive and gram-negative bacteria are the most frequent agents, with variable frequencies depending on the type of transplantation [6]. Mortality rates range from 11–33 %, with higher rates occurring among heart transplant patients [7]. Little is known about the differences between bacteremia from gram-negative and gram-positive bacteria in the setting of solid organ transplantation and their specific impact on mortality. This retrospective study aims to evaluate these two issues

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