title: Bloodstream infection following 217 consecutive systemic-enteric drained pancreas transplants.
abstract: BACKGROUND
  Combined kidney pancreas transplantation (PTx) evolved as excellent treatment for diabetic nephropathy. Infections remain common and serious complications.
  
  
  METHODS
  217 consecutive enteric drained PTxs performed from 1997 to 2004 were retrospectively analyzed with regard to bloodstream infection. Immunosuppression consisted of antithymocyteglobuline induction, tacrolimus, mycophenolic acid and steroids for the majority of cases. Standard perioperative antimicrobial prophylaxis consisted of pipercillin/tazobactam in combination with ciprofloxacin and fluconazole.
  
  
  RESULTS
  One year patient, pancreas and kidney graft survival were 96.4%, 88.5% and 94.8%, surgical complication rate was 35%, rejection rate 30% and rate of infection 59%. In total 46 sepsis episodes were diagnosed in 35 patients (16%) with a median onset on day 12 (range 1-45) post transplant. Sepsis source was intraabdominal infection (IAI) (n = 21), a contaminated central venous line (n = 10), wound infection (n = 5), urinary tract infection (n = 2) and graft transmitted (n = 2). Nine patients (4%) experienced multiple episodes of sepsis. Overall 65 pathogens (IAI sepsis 39, line sepsis 15, others 11) were isolated from blood. Gram positive cocci accounted for 50 isolates (77%): Coagulase negative staphylococci (n = 28, i.e. 43%) (nine multi-resistant), Staphylococcus aureus (n = 11, i.e. 17%) (four multi-resistant), enterococci (n = 9, i.e. 14%) (one E. faecium). Gram negative rods were cultured in twelve cases (18%). Patients with blood borne infection had a two year pancreas graft survival of 76.5% versus 89.4% for those without sepsis (p = 0.036), patient survival was not affected.
  
  
  CONCLUSIONS
  Sepsis remains a serious complication after PTx with significantly reduced pancreas graft, but not patient survival. The most common source is IAI.
authors.affiliation: Department of General and Transplant Surgery, Medical University, Innsbruck, Austria. Natalie.Berger@uibk.ac.at
authors.forename: Natalie
authors.initials: N
authors.lastname: Berger
authors.forename: Sigmund
authors.initials: S
authors.lastname: Guggenbichler
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Steurer
authors.forename: Christian
authors.initials: C
authors.lastname: Margreiter
authors.forename: Gert
authors.initials: G
authors.lastname: Mayer
authors.forename: Reinhold
authors.initials: R
authors.lastname: Kafka
authors.forename: Walter
authors.initials: W
authors.lastname: Mark
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Rosenkranz
authors.forename: Raimund
authors.initials: R
authors.lastname: Margreiter
authors.forename: Hugo
authors.initials: H
authors.lastname: Bonatti
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects*; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology* / Q000382:microbiology