title: Bloodstream infections in liver transplant recipients receiving tacrolimus.
abstract: The microbial origin, timing, risk factors, and outcome of bloodstream infections (bacteremia and fungemia) were prospectively analyzed in 130 consecutive liver transplant recipients receiving tacrolimus-based immunosuppression; median followup was 3 yr. 22% (29/130) of the patients developed 36 episodes of bloodstream infections (0.28 episodes/patient). Bloodstream infections accounted for 36% (36/100) of all major infections. 81% (29/36) of bloodstream infections were due to bacteremia and 19% (7/36) due to fungemia (candidemia 14% and cryptococcemia 5%). Intravascular catheters were the most frequent source and methicillin-resistant Staphylococcus aureus was the most frequent pathogen causing bloodstream infections. 70% of the catheter related and all bacteremias due to intra-abdominal infections occurred < or = 90 d, whereas 75% of the bacteremias due to biliary source occurred > 90 d after transplantation. Length of initial post-transplant intensive care unit stay (p = 0.014) and readmission to the intensive care unit (p = 0.003) were independently significant predictors of bloodstream infections. 40% of the candidemias occurred within 30 d of transplantation and were of unknown portal, whereas the portal in all candidemias occurring > 30 d post-transplant was known (catheter, hepatic abscess, urinary tract). Mortality in patients with bloodstream infections was 52% (15/29) vs. 9% (9/101) in patients without bloodstream infections (p = 0.0001). In conclusion, intravascular catheters (and not intra-abdominal infections) have emerged as the most common source of bloodstream infections, and gram-positive cocci (S. aureus) as the predominant pathogens in bloodstream infections after liver transplantation.
authors.affiliation: VA Medical Center, Infectious Disease Section, Pittsburgh, PA 15240, USA.
authors.forename: N
authors.initials: N
authors.lastname: Singh
authors.forename: T
authors.initials: T
authors.lastname: Gayowski
authors.forename: M M
authors.initials: MM
authors.lastname: Wagener
authors.forename: I R
authors.initials: IR
authors.lastname: Marino
mesh_terms: D000005:Abdomen / Q000382:microbiology; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000209:etiology*; D001659:Biliary Tract / Q000382:microbiology; D002177:Candidiasis / Q000209:etiology; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation; D003422:Critical Care; D003453:Cryptococcosis / Q000209:etiology; D004866:Equipment Contamination; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D016469:Fungemia / Q000209:etiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007902:Length of Stay; D008100:Liver Abscess / Q000382:microbiology; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D010359:Patient Readmission; D011446:Prospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000209:etiology; D013211:Staphylococcus aureus / Q000187:drug effects; D015996:Survival Rate; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000382:microbiology
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus