Spectrum of severe infections in an Asian renal transplant population.
Infections in renal transplant recipients (RTX) account for 26% of hospitalization days annually and 40% of overall mortalities. A retrospective study of infections requiring hospitalization occurring among 725 Asian RTX in 2002 was performed.


RESULTS
Serious infections requiring at least one hospitalization occurred in 9.2% of RTX (n = 67). Multiple pathogens affected 28.4% of patients, resulting in 118 infectious episodes during 93 hospitalizations. Mean age of affected patients was 48 years and female to male ratio was 2:1. Forty-one (61.2%) had impaired renal function (serum creatinine >141 mumol/L). Mean duration of hospitalization per patient was 17 days and the in-patient mortality rate was 17.9% eighty-one (87%) hospitalizations were for late infections (>6 months posttransplant). Cyclosporine (CsA) with prednisolone with or without azathioprine was the immunosuppressant in 62.7% (n = 42) of RTX but proportionally, infections were more frequent among RTX on other more potent immunosuppressants (n = 21; 7.4% CsA-based vs. 19.3%, potent, P < .05). Bacterial, viral, fungal, and Pneumocystis carinii infections comprised 64.4%, 20.3%, 5.9%, and 4.2% respectively. Urinary tract infection, pneumonia, and bacterial septicemia (35.52%, 31.6%, and 11.8%, respectively) were the major presentations. E. coli, cytomegalovirus (CMV), and Candida were the most common pathogens. Notably, 13 out of 18 (72.2%) viral CMV infections were co- infections, occurring together with bacterial infections.


CONCLUSIONS
Late infections with the use of potent immunosuppressives and concurrent CMV reactivation are a major cause of morbidity. Longer antibacterial prophylaxis and closer monitoring for CMV infections may help reduce morbidity.
Kee
T
T
Department of Renal Medicine, Singapore General Hospital, Singapore. grmkys@sgh.com.sg
Lu
Y M
YM
Vathsala
A
A
D001208:Asia; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007239:Infections / Q000145:classification / Q000453:epidemiology*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D008875:Middle Aged
D007166:Immunosuppressive Agents