title: Severe infections requiring intensive care unit admission in kidney transplant recipients: impact on graft outcome.
abstract: BACKGROUND
  Kidney transplant recipients are at risk for life-threatening infections, which may affect the long-term prognosis.
  
  
  METHODS
  We retrospectively included all kidney transplant recipients admitted for sepsis, severe sepsis, or septic shock to the medical intensive care unit (ICU) of the Saint-Louis Hospital, Paris, France, between 2000 and 2010. The main objective was to identify factors associated with survival without graft impairment 90 days after ICU discharge.
  
  
  RESULTS
  Data were available for 83 of 100 eligible patients. The main sites of infection were the lungs (54%), urinary tract (24%), and bloodstream (22%). Among documented infections (55/83), 80% were bacterial. Fungal infections were more common among patients transplanted after 2005 (5% vs. 23%, P = 0.02). Mechanical ventilation was used in 46 (56%) patients, vasopressors in 39 (47%), and renal replacement therapy (RRT) in 34 (41%). In-hospital and day-90 mortality rates were 20% and 22%, respectively. On day 90, among the 65 survivors, 39 (47%) had recovered their previous graft function and 26 (31%) had impaired graft function, including 16 (19%) who were dependent on RRT. Factors independently associated with day-90 survival and graft function recovery were baseline serum creatinine (odds ratio [OR] for a 10 μmol/L increase 0.94, 95% confidence interval [CI] 0.88-1.00) and cyclosporine therapy (OR 0.30, 95% CI 0.11-0.79).
  
  
  CONCLUSIONS
  Sepsis was chiefly related to bacterial pneumonia or urinary tract infection. Pneumocystis jirovecii was the leading opportunistic agent, with a trend toward an increase over time. Infections often induced severe graft function impairment. Baseline creatinine and cyclosporine therapy independently predicted the outcome.
authors: Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France.
authors: N
authors: N
authors: Bige
authors: L
authors: L
authors: Zafrani
authors: J
authors: J
authors: Lambert
authors: M-N
authors: MN
authors: Peraldi
authors: R
authors: R
authors: Snanoudj
authors: D
authors: D
authors: Reuter
authors: C
authors: C
authors: Legendre
authors: S
authors: S
authors: Chevret
authors: V
authors: V
authors: Lemiale
authors: B
authors: B
authors: Schlemmer
authors: E
authors: E
authors: Azoulay
authors: E
authors: E
authors: Canet
mesh_terms: D001424:Bacterial Infections / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D006084:Graft Rejection; D006760:Hospitalization; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007362:Intensive Care Units; D016030:Kidney Transplantation / Q000009:adverse effects*; D009894:Opportunistic Infections / Q000382:microbiology*; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000209:etiology / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D007166:Immunosuppressive Agents
keywords: immunosuppressive drugs; infection; intensive care unit; kidney transplantation