CAMUS C, GACOUIN A, LAVOUE S, HOFF J, LE TULZO Y, BOUDJEMA K, THOMAS R; Interscience Conference on Antimicrobial Agents and Chemotherapy (41st : 2001 : Chicago, Ill.).
Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2001 Dec 16-19; 41: abstract no. K-1255.
CHR, Rennes, France
BACKGROUND: bacterial infection is the most frequent cause of infection after liver transplantation (LT) and usually occurs within 30 post-operative days. The influence on survival has been poorly assessed. Methods : we prospectively studied early-onset bacterial infections (EBIs) (=30 days after LT), identified risk factors and determined the role on mortality in 258 consecutive patients who underwent LT from January 1994 to August 2000. Risk factors for EBI were identified by stepwise logistic regression with the use of the Coxs proportional hazards regression model. Survival curves were compared with the log-rank test. Risk ratio for death associated with EBI was adjusted for prognostic variables. RESULTS: 86 patients (33.3%) developed 132 episodes of pneumonia (n=32), bacteremia (n=27), intra-abdominal (n=24), biliary (n=11), urinary tract (n=10), digestive (n=3), miscellaneous (n=25). 32 episodes (24.2%) were polymicrobial (24.2%). P. aeruginosa (20/132 [22.7%]) and methicillin-resistant S. aureus (28/132 [21.2%]) were the main two responsible agents. Length of stay (P=0.0002), dialysis (P=0.0006), major inta-abdominal bleeding (P=0.03) and hepatic artery thrombosis (P=0.03) were identified as independent risk factors. The development of EBI was associated with shorter survival (P<0.0001). After adjustment for SAPS II, liver disease, emergency LT, study period, type of anti-calcineurin, arterial thrombosis, major post-operative bleeding, fungal infection and late-onset bacterial infection, the risk ratio for death associated with EBI was 2.05 (95% CI 1.15 to 3.63, P=0.01). As compared with other etiologies, P. aeruginosa infection was associated with shorter survival (P=0.007). CONCLUSION: EBIs are a major cause of morbidity and mortality after LT. Prevention measures could not readily be based on risk factors that were identified in our study. They should target P. aeruginosa and methicillin-resistant S. aureus.
Publication Types:
Keywords:
- Bacteremia
- Bacterial Infections
- Graft Survival
- Humans
- Liver Transplantation
- Logistic Models
- Mycoses
- Pneumonia
- Proportional Hazards Models
- Risk Factors
- Survival
- immunology
- mortality
- surgery
- transplantation
Other ID:
UI: 102269815
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