SINGH N, WAGENER MM, OBMAN A, GAYOWSKI T; Interscience Conference on Antimicrobial Agents and Chemotherapy (43rd: 2003: Chicago, Ill.).
Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2003 Sep 14-17; 43: abstract no. K-1371.
VA Med. Ctr., Pittsburgh, PA.
BACKGROUND: Through the mid-1990s, Gram-positive bacteria continued to emerge as major pathogens after liver transplantation (CID 00). We sought to determine whether the spectrum and types of pathogens associated with bacteremias in liver transplant recipients have changed. METHODS: Patients included 233 consecutive liver transplant recipients transplanted at our institution between 1989-2003. Antimicrobial prophylactic practices have remained unchanged. The 14 year study period was divided into quartiles and trends assessed by Chi-square. RESULTS: Bacteremias occurred in 33.9% (79/233) of the patients. Proportion of all infections that were due to bacteremias increased significantly over time (p<.0001, from 15.7% in 1989-93 to 62.7% in 1998-03). Of other etiologic pathogens associated with major infections, a decrease in fungal infections (p=.08) and a significant decrease in CMV disease (p=.0004) was documented. Whereas, the proportion of bacteremias that were due to Gram-negatives increased from 25% in 1989-93 to 51.8% in 1998-03, that of Gram-positive bacteria decreased from 75% in 1989-93 to 48.2% in 1998-03. MRSA (41%, 33/79), Klebsiella 13.9% (11/79), and Pseudomonas 12.7% (10/79) were the 3 most frequent pathogens in bacteremic patients. The incidence of bacteremias due to MRSA and Pseudomonas has remained unchanged(p>0.20). However, the incidence and the proportion of bacteremias due to Klebsiella have increased significantly (p=.02). By PFGE, 3 of 5 Klebsiella isolates from patients in the current quartile were unrelated and 2/5 were possibly related. No changes in the time of onset of bacteremia have occurred. CONCLUSIONS: Bacteremias as a proportion of all infections in liver transplant recipients have increased significantly over time (due in part to a decline in infections due to other pathogens e.g., fungi and CMV). Gram-negative bacteria have emerged as predominant pathogens in bacteremic liver transplant recipients.
Publication Types:
Keywords:
- Bacteremia
- Gram-Negative Bacteria
- Humans
- Incidence
- Klebsiella
- Klebsiella pneumoniae
- Liver Transplantation
- Mycoses
- Staphylococcal Infections
- Staphylococcus aureus
- surgery
- transplantation
- trends
Other ID:
UI: 102265357
From Meeting Abstracts