title: Risk factors for infections requiring hospitalization in renal transplant recipients: a cohort study.
abstract: OBJECTIVE
  Our aim was to analyze a retrospective cohort of renal transplant recipients to determine the risk factors for infections that require hospitalization.
  
  
  METHODS
  This was a cohort study that included patients who had received kidney transplants from January 1990 to December 2003. The statistical analysis was performed according to the distribution of variables, and p<0.05 was considered statistically significant.
  
  
  RESULTS
  We analyzed 366 transplants in 350 patients, of whom 161 (46%) presented with an episode of infection requiring hospitalization. These 161 patients developed 323 infections (a median of two infections per patient). The incidence rate was 0.46 episodes per 1000 transplant-days. Urinary tract infection, pneumonia, bacteremia, and gastroenteritis were the most common diseases. A high incidence of infections due to Escherichia coli and Enterococcus species, as well as Candida species, was found. By multivariate Cox model, significant risk factors for infections requiring hospitalization were systemic lupus erythematosus (relative risk (RR) 4.8, 95% confidence interval (CI) 1.64-14.1), cancer (RR 3.81, 95% CI 1.05-13.7), previous renal transplant (RR 5.6, 95% CI 1.4-22.4), history of anti-rejection therapy (RR 3.2, 95% CI 1.3-8.0), and a basal serum albumin concentration<3.5mg/dl (RR 1.77, 95% CI 1.17-2.68). Interestingly, dyslipidemia (RR 0.5, 95% CI 0.37-0.69) and end-stage renal disease of unknown etiology (RR 0.5, 95% CI 0.3-0.8) were protective factors against hospitalization.
  
  
  CONCLUSIONS
  These data suggest that the most common infections requiring hospitalization in our cohort were those caused by microorganisms commonly related with community-acquired infections rather than those classically associated with immunosuppressant therapy. These findings will be useful for refining medical care.
authors.affiliation: Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Colonia Sección XVI, CP 14000, Delegación Tlalpan, Mexico City, Mexico.
authors.forename: Rafael
authors.initials: R
authors.lastname: Valdez-Ortiz
authors.forename: José
authors.initials: J
authors.lastname: Sifuentes-Osornio
authors.forename: Luis E
authors.initials: LE
authors.lastname: Morales-Buenrostro
authors.forename: Harold
authors.initials: H
authors.lastname: Ayala-Palma
authors.forename: Edgar
authors.initials: E
authors.lastname: Dehesa-López
authors.forename: Josefina
authors.initials: J
authors.lastname: Alberú
authors.forename: Ricardo
authors.initials: R
authors.lastname: Correa-Rotter
mesh_terms: D000328:Adult; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors