One Year Incidence of Infection in Intestine Transplant Recipients at a Single Center

Abstract

Introduction: This study reports the infection rate, location of infection, and pathogen causing bacterial, fungal, or viral infections in intestine transplant recipients during the first year post-transplant at an active transplant center. Additional risk for infection was assessed based on simultaneous inclusion of the liver or colon as a part of the intestine transplant. Methods: Records from a single transplant center were reviewed for patients receiving an intestine transplant. Positive cultures and pathology reports were used to diagnose bacterial, fungal, and viral infections and also to determine location and infectious agent. For analysis, patients were grouped by age (pediatric or adult). Results: During the study period, 236 intestine transplants were performed, 184 adults and 52 pediatric patients. In adults, one year bacterial, fungal, and viral infection rates were 91%, 47%, and 29%, respectively. The most commonly infected sites were the urinary tract and bloodstream. Coagulase-negative Staphylococcus was the most commonly isolated pathogen and found in 48% of patients. Candida species were the most common fungal pathogens and seen in 42% of all patients, and in 89% of patients who developed a fungal infection. Cytomegalovirus infections were present in 15% of transplant recipients. Bacterial and fungal bloodstream infections (BSI) developed in 72% of patients with a median time to first infection of 30 days. Among pediatric patients, bacterial, fungal, and viral infection rates were 90%, 25%, and 75%, respectively. Vancomycin susceptible enterococci were the most common pathogens and isolated from 52% of patients. Candida species were the most common fungal pathogens and observed in 23% of patients. Upper respiratory viral infections were common (44%) and cytomegalovirus infection rate was 17%. The most common sites of infection were bloodstream, urinary, and upper respiratory tract. The median days to the first BSI was 38 days. Conclusion: Overall, 91% of adult and 90% of pediatric intestine transplant patients had a bacterial infection in the first year post-transplant. Opportunistic fungal and viral infections were also common. Age, gender, race, or liver inclusion did not have a significant impact on the development of a BSI or median time to first BSI. Colon inclusion significantly (p < .05) decreased the risk of developing a BSI in pediatric patients, while not having a significant impact on median days to first BSI or development of a BSI in adults. The two tables below represent a portion of the data analyzed.FigureFigure