title: Trauma after transplant: hold the antibiotics please.
abstract: OBJECTIVE
  Despite the increase in transplantation and the prevalence of trauma as a major disease entity, few data exist about transplant patients who suffer trauma. We conducted a study to determine whether transplant patients (TP) have worse outcomes, particularly of infections, than do their non-transplant (NTP) counterparts after trauma.
  
  
  METHODS
  We performed a retrospective review of trauma patients from 2006 to 2010. All patients who had undergone organ transplantation were included and compared through 1:3 propensity matching with their NTP counterparts. Data for the groups were compared to determine differences in outcomes.
  
  
  RESULTS
  The review included 17 TP (13 kidney, 2 liver, 1 kidney/liver, and 1 kidney/pancreas) as compared with 51 NTP. The patients were matched for injury severity score (ISS), age, and gender, with most suffering blunt trauma (82.4% [14/17] TP vs. 90% [46/51] NTP, p = 0.5). The groups had similar initial Glasgow Coma Scale (GCS) scores (13.2 ± 4.5 TP vs. 13.9 ± 2.5 NTP, p=0.6), serum lactate concentrations (2.0 ± 1.8 mmol/L TP vs. 2.3 ± 1.5 mmol/L NTP, p=0.39), and base deficits (-1.5 ± 4.0 TP vs. 0.6 ± 3.0 NTP, p=0.21). Comorbidities were more common in the TP than in the NTP group. The groups had similar lengths of stay (days on ventilator: 0.1 ± 0.3 TP vs. 0.4 ± 1.6 NTP, p=0.9; days in ICU: 0.2 ± 0.6 TP vs. 2.4 ± 5.9 NTP, p=0.16; days in hospital: 5.2 ± 6.8 TP vs. 7.5 ± 10.2 NTP, p=0.86), and two deaths occurred in each of the two groups (p=0.26). Overall complications were similar (52.94% [9/17] TP vs. 62.75% [32/51] NTP, p=0.57), and there were only two infections, both in the NTP group (p=1.0). Antibiotics were given to 59% of the TP vs. 39% of the NTP, with an average duration of 8.4 days for the TP vs. 3.9 days for the NTP.
  
  
  CONCLUSIONS
  When matched equally for degree of injury, the TP and NTP had similar outcomes. There also appeared to be no differences in infectious complications in the two groups, yet more of the TP had exposure to more days of antibiotics. Similar protocols of antimicrobial therapy should apply to both TP and NTP to avoid the overuse of antimicrobial agents and ensure maintenance of the susceptibility patterns of pathogens.
authors: Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia 23298, USA.
authors: Jeffrey M
authors: JM
authors: Tessier
authors: Maxwell
authors: M
authors: Sirkin
authors: Luke G
authors: LG
authors: Wolfe
authors: Therese M
authors: TM
authors: Duane
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014180:Transplantation / Q000706:statistics & numerical data*; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents