Impact of solid organ transplantation and immunosuppression on fever, leukocytosis, and physiologic response during bacterial and fungal infections.
Immunosuppressed solid organ transplant patients may exhibit a blunted response to infection compared to non-transplant patients. To test this hypothesis, we prospectively identified all episodes of bacterial and fungal infection on the in-patient abdominal organ transplant service in our hospital, in 1997, and compared them to infected general surgery and trauma admissions treated simultaneously on the same wards. Eighty-two infections occurred in transplant patients versus 463 in non-transplant patients. Transplant patients demonstrated an overall greater physiologic response [Acute Physiology and Chronic Health Evaluation (APACHE II) and Acute Physiology Scores (APS) at the time of infection of 17.0+/-0.7 and 10.3+/-0.6, respectively, vs. 12.2+/-0.4 and 8.0+/-0.3 for non-transplant patients, p < 0.003], with a similar maximum temperature (38.0+/-0.1 vs. 38.2+/-0.1 degrees C, p = 0.2) and white blood cell (WBC) count (12.1+/-1.0 vs. 13.9+/-0.4 k/mL, p = 0.08). Upon further analysis of subgroups, patients receiving mycophenolate or azathioprine had significantly lower maximum temperatures (37.9+/-0.2 degrees C) and WBC counts (11.0+/-0.9 k/mL) when compared to non-transplant patients, while steroids appeared to have little effect on the systemic inflammatory response. Overall mortality was similar between groups. In general, solid organ transplant recipients exhibit a physiologic response to bacterial or fungal infection (as measured by the APS) at least as great as that seen in non-transplant surgical patients, although mycophenolate and azathioprine appear to slightly depress the ability to respond with fever and leukocytosis. None of these differences appeared to affect overall mortality.
Sawyer
R G
RG
Charles O. Strickler Transplant Center, Department of Surgery, University of Virginia, Charlottesville 22906-0005, USA. rw2k@virginia.edu
Crabtree
T D
TD
Gleason
T G
TG
Antevil
J L
JL
Pruett
T L
TL
D018806:APACHE; D001424:Bacterial Infections / Q000453:epidemiology / Q000276:immunology*; D016009:Chi-Square Distribution; D005334:Fever / Q000453:epidemiology / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007964:Leukocytosis / Q000453:epidemiology / Q000276:immunology*; D009181:Mycoses / Q000453:epidemiology / Q000276:immunology*; D009894:Opportunistic Infections / Q000453:epidemiology / Q000276:immunology*; D016377:Organ Transplantation; D011446:Prospective Studies
D007166:Immunosuppressive Agents