title: Infections and severe sepsis in solid-organ transplant patients admitted from a university-based ED.
abstract: The objective was to provide a descriptive analysis of infectious processes in transplant patients admitted from the emergency department (ED). A database of all adult transplant patients at a university medical center was cross-referenced with a computerized record of all ED visits over an 18-month period. ED charts, inpatient records, and microbiology data were retrospectively reviewed. Final diagnoses and outcomes were analyzed. There were 352 ED visits by transplant patients (kidney 66%, kidney/pancreas 15%, liver 13%, lung 3%, heart 3%). Infections were the most common indications for admission (77/217, 35%). Urinary tract infection and pneumonia were the most common infections. Nine of 77 patients (11.7%) with documented infections developed severe sepsis, which was the most common reason for ICU utilization. Thirty-five percent of transplant patients admitted from the ED had acute infections, and 11.7% of these patients had severe sepsis. The emergency physician must have a high index of suspicion for infections when evaluating organ transplant recipients.
authors.affiliation: Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL, USA. TRZECIAK-STEPHEN@cooperhealth.edu
authors.forename: Stephen
authors.initials: S
authors.lastname: Trzeciak
authors.forename: Randall
authors.initials: R
authors.lastname: Sharer
authors.forename: Derek
authors.initials: D
authors.lastname: Piper
authors.forename: Therese
authors.initials: T
authors.lastname: Chan
authors.forename: Chad
authors.initials: C
authors.lastname: Kessler
authors.forename: R Phillip
authors.initials: RP
authors.lastname: Dellinger
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Pursell
mesh_terms: D000328:Adult; D001424:Bacterial Infections / Q000453:epidemiology*; D003422:Critical Care / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D016027:Heart Transplantation / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D016031:Liver Transplantation / Q000706:statistics & numerical data; D016040:Lung Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D018410:Pneumonia, Bacterial / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology*; D019737:Transplants / Q000706:statistics & numerical data*; D014552:Urinary Tract Infections / Q000453:epidemiology