title: Staphylococcus aureus infections in kidney transplantation: a matched case controlled study.
abstract: BACKGROUND
  Data are lacking on the risk factors and outcomes of Staphylococcus aureus infections in kidney transplant recipients.
  
  
  METHODS
  Kidney recipients with S. aureus infections (n = 20) were retrospectively identified and compared to age- and transplant-type-matched (1:2) non-S. aureus-infected controls (n = 40). Risk factors for S. aureus infections were identified by conditional logistic regression analysis.
  
  
  RESULTS
  Methicillin-resistant S. aureus (MRSA) was the cause of 32.1% of infections. Localizations of the infections were as follows: skin 42.9%, intra-abdominal 35.7%, blood stream 7.1%, and pulmonary 10.7%. The infections developed at a median time of 29 days (range 0-358 days) after transplantation. By univariate analysis, variables significantly associated with infection were steroid administration 4 weeks prior to infection (odds ratio (OR) 4.2, 95% confidence interval (95% CI) 1.1-15.8; p = 0.03) and the presence of a central venous catheter 7 days prior to infection (OR 5.6, 95% CI 1.1-27.8; p = 0.03). By multivariate analysis, subjects with steroid treatment during the previous 4 weeks had a 6.13-times higher risk of developing S. aureus infection (95% CI 1.5-25.7; p = 0.01), and the risk of infection decreased by a factor of 0.65 for every 1-y increase in age (95% CI 0.44-0.97; p = 0.03); these results were adjusted for matched criteria. Post-infection outcomes (cases vs controls) included graft loss (10% vs 0%; p = 0.11) and 12-month mortality (0% vs 2.5%; p = 0.99).
  
  
  CONCLUSIONS
  Younger age and steroid treatment were significant independent risk factors associated with S. aureus infections after kidney transplantation. Graft and patient survival were not affected, but the study was not powered for these outcomes.
authors.affiliation: Infectious Diseases Division, Transplant Infectious Diseases Program, University of Nebraska Medical Center, Omaha, Nebraska 68198-5400, USA. dfl orescu@unmc.edu
authors.forename: Diana F
authors.initials: DF
authors.lastname: Florescu
authors.forename: Fang
authors.initials: F
authors.lastname: Qiu
authors.forename: Sara Brostrom
authors.initials: SB
authors.lastname: West
authors.forename: Sarah
authors.initials: S
authors.lastname: Richards
authors.forename: Marius C
authors.initials: MC
authors.lastname: Florescu
authors.forename: Brian
authors.initials: B
authors.lastname: Stevens
authors.forename: Lisa
authors.initials: L
authors.lastname: Hill
authors.forename: Andre C
authors.initials: AC
authors.lastname: Kalil
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D007223:Infant; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000401:mortality; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D013256:Steroids / Q000008:administration & dosage / Q000009:adverse effects; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids