Risk factors, clinical features, and outcomes of listeriosis in solid-organ transplant recipients: a matched case-control study.
BACKGROUND
Solid-organ transplant (SOT) recipients are classically considered to be at increased risk for listeriosis. However, risk factors for this infection have not been assessed.


METHODS
We carried out a multicenter, matched case-control study (1:2 ratio) from January 1995 through December 2007. Control subjects were matched for center, transplant type, and timing. Conditional logistic regression was performed to identify independent risk factors. Clinical features and outcomes for all case patients were reviewed.


RESULTS
Thirty patients (0.12%) with cases of listeriosis were identified among 25,997 SOT recipients at 15 Spanish transplant centers. In a comparison of case patients with 60 matched control subjects, the following independent risk factors for listeriosis were identified: diabetes mellitus (odds ratio [OR], 5.6; 95% confidence interval [CI], 1.6-19.6; ), P = .007 history of cytomegalovirus infection or disease within the preceding 6 months (OR, 35.9; 95% CI, 2.1-620; P = .014), receipt of high-dose prednisone within the preceding 6 months (OR, 6.2; 95% CI, 1.8-21.1; P = .003), and trimethoprim-sulfamethoxazole (TMP-SMZ) prophylaxis (OR, 0.07; 95% CI, 0.006-0.76; P = .029). Twenty-six patients (86.7%) had bacteremia, and 7 had shock at presentation. Other manifestations included meningoencephalitis (10 cases), spontaneous peritonitis (2), pleural empyema (1), brain abscesses (1), and liver abscesses (1). The 30-day mortality rate was 26.7% (8 of 30 patients died).


CONCLUSIONS
Listeriosis in SOT recipients is uncommon but causes high mortality. Diabetes mellitus, cytomegalovirus infection or disease, and receipt of high-dose steroids are independent risk factors for this infection, whereas TMP-SMZ prophylaxis is a protective factor.
Fernàndez-Sabé
Núria
N
Infectious Disease Service, Intitut d'Investigació Biomèdica de Bellvitge -Hospital Universitari de Bellvitge, Barcelona, Spain.
Cervera
Carlos
C
López-Medrano
Francisco
F
Llano
Miguel
M
Sáez
Elena
E
Len
Oscar
O
Fortún
Jesús
J
Blanes
Marino
M
Laporta
Rosa
R
Torre-Cisneros
Julián
J
Gavaldà
Joan
J
Muñoz
Patricia
P
Fariñas
M Carmen
MC
María Aguado
José
J
Moreno
Asunción
A
Carratalà
Jordi
J
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003586:Cytomegalovirus Infections / Q000150:complications; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D008088:Listeriosis / Q000453:epidemiology / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013256:Steroids / Q000009:adverse effects / Q000627:therapeutic use; D019737:Transplants / Q000009:adverse effects*; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D055815:Young Adult
D013256:Steroids; D015662:Trimethoprim, Sulfamethoxazole Drug Combination