title: Risk factors and outcomes of Staphylococcus aureus infections after small bowel and multivisceral transplantation.
abstract: BACKGROUND
  No studies have evaluated the risk factors and outcomes of Staphylococcus aureus (SA) infections in small bowel (SBT) and multivisceral (including small bowel) transplantation (MVT).
  
  
  METHODS
  SBT and MVT recipients with SA infections (22 cases) were retrospectively identified and compared with matched non-SA-infected recipient controls (44). The characteristics were compared with Friedman and Cochran-Mantel-Haenszel tests. Conditional logistic regression analysis was performed to identify risk factors, and Kaplan-Meier curve and Cox proportional hazard model were performed for survival analysis.
  
  
  RESULTS
  The median age was 2.07 years (range, 0.76-54.04). Forty-three percent of the first SA infections were bloodstream infections, 30% lung infections, and 26% surgical site infections; 36% of these isolates were methicillin-resistant SA. Median time (days) to surgical site infections (41.0; range, 0-89) was significantly shorter than that to lung infections (266; range, 130-378) (P = 0.01). By univariate analysis, it was found that cases were more likely to have cytomegalovirus (CMV) sero-mismatch (odds ratio [OR] = 3.03 [95% confidence interval, 0.88-10.43]; P = 0.08), and controls were more likely to receive mycophenolate mofetil (MMF) treatment (0.09 [0.001-0.82]; P = 0.03). By multivariable analysis, patients with CMV sero-mismatch were found to have higher odds of developing SA infection (OR, 2.92; P = 0.085), whereas MMF had a protective effect (OR, 0.08; P = 0.031), adjusting for matched criteria. SA cases had shorter survival than controls (mean survival, 28.5 vs. 45.8 months [P = 0.04]) and were 2.18 times more likely to die (1.02-4.67, P = 0.04).
  
  
  CONCLUSIONS
  SA infections were associated with a significant shorter survival time and higher risk of death. The presence of CMV sero-mismatch and the absence of MMF treatment were found to be the risk factors for SA infections after SBT and MVT.
authors.affiliation: Infectious Diseases Section, University of Nebraska Medical Center, Omaha, NE 68198-5400, USA. dflorescu@unmc.edu
authors.forename: Diana F
authors.initials: DF
authors.lastname: Florescu
authors.forename: Fang
authors.initials: F
authors.lastname: Qiu
authors.forename: Renuga
authors.initials: R
authors.lastname: Vivekanandan
authors.forename: David F
authors.initials: DF
authors.lastname: Mercer
authors.forename: Alan N
authors.initials: AN
authors.lastname: Langnas
authors.forename: Andre C
authors.initials: AC
authors.lastname: Kalil
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007421:Intestine, Small / Q000473:pathology / Q000637:transplantation*; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000209:etiology* / Q000382:microbiology / Q000401:mortality*; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D016019:Survival Analysis; D014781:Viscera / Q000473:pathology / Q000637:transplantation*; D055815:Young Adult