title: Six-month incidence of bloodstream infections in intestinal transplant patients.
abstract: BACKGROUND
  Intestinal transplantation has emerged as an established treatment for life-threatening intestinal failure. The most common complication and cause of death is infection. Risk of infection is highest during the first 6 months, as a consequence of maximal immunosuppression, greater than that required for any other organ allograft.
  
  
  METHODS
  We performed a retrospective chart review of all (56) adult and pediatric (<18 years) small bowel transplant patients at our institution between November 2003 and July 2007, and analyzed the 6-month post-transplant incidence of bloodstream infections (BSIs). We evaluated multiple risk factors, including inclusion of a colon or liver, total bilirubin >5, surgical complications, and acute rejection.
  
  
  RESULTS
  A BSI developed in 34 of the 56 patients, with a total of 85 BSI episodes. Of these BSI episodes, 65.9% were due to gram-positive organisms, 34.1% gram-negative organisms, and 2.4% due to fungi. The most common isolates were Enterococcus species, Enterobacter species, Klebsiella species, and coagulase-negative staphylococci. Inclusion of the liver and/or a preoperative bilirubin >5 mg/dL appeared to increase the incidence of BSI (P = 0.0483 and 0.0005, respectively). Acute rejection and colonic inclusion did not appear to affect the incidence of BSI (P = 0.9419 and 0.8248, respectively). The BSI incidence was higher in children (P = 0.0058).
  
  
  CONCLUSIONS
  BSIs are a common complication of intestinal transplantation. Risk factors include age <18, inclusion of the liver, and pre-transplant bilirubin >5. Acute rejection and colon inclusion do not appear to be associated with increased BSI risk.
authors.affiliation: Infectious Diseases Faculty Practice, Orlando Health, Orlando, Florida 32806, USA. kauser.akhter@orlandohealth.com
authors.forename: K
authors.initials: K
authors.lastname: Akhter
authors.forename: J
authors.initials: J
authors.lastname: Timpone
authors.forename: C
authors.initials: C
authors.lastname: Matsumoto
authors.forename: T
authors.initials: T
authors.lastname: Fishbein
authors.forename: S
authors.initials: S
authors.lastname: Kaufman
authors.forename: P
authors.initials: P
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D001419:Bacteria / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007421:Intestine, Small / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult