Characteristics of vertebral osteomyelitis after liver transplantation.
We performed a retrospective single-centre 1:3 case-control study to investigate the characteristics of vertebral osteomyelitis (VO) occurring in orthotopic liver transplant (OLT) recipients between 2000 and 2012. Nine cases were identified in 752 OLT recipients (1.2%), with a median time from OLT to VO of 12 weeks. In comparison with 27 VO not occurring in OLT patients (controls), VO occurring in OLT recipients was characterized by decreased levels of inflammation biomarkers (average C-reactive protein 65.1 mg·L(-1) vs. 167 mg·L(-1), p 0.02; average white blood cell count 4.8 × 10(9)·L(-1) vs. 12.9 × 10(9)·L(-1), p < 0.001), higher rate of fungal infections (3/9 vs. 0/27, p 0.01), lower rate of bacterial infections (3/9 vs. 25/27, p 0.001) and decreased proportion of positive blood cultures (1/9 vs. 16/27, p 0.02) despite a trend towards higher rate of multifocal infection. Microbiologic outcomes were similar between the two groups. Overall, VO in OLT patients was more difficult to diagnose as a result of altered inflammation response and specific microbial epidemiology of causal microorganisms.
Department of Internal Medicine, France.
R
R
Buzelé
Department of Internal Medicine, France.
V
V
Zarrouk
Department of Hepatology and Liver Intensive Care, Assistance Publique-Hôpitaux de Paris, Clichy, France.
C
C
Francoz
Department of Hepatology and Liver Intensive Care, Assistance Publique-Hôpitaux de Paris, Clichy, France.
F
F
Durand
Department of Internal Medicine, France. Electronic address: bruno.fantin@bjn.aphp.fr.
B
B
Fantin
D000328:Adult; D001419:Bacteria / Q000302:isolation & purification; D016022:Case-Control Studies; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D016867:Immunocompromised Host; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology*; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology*
Fungal infection; blood inflammatory markers; liver transplant; microbiological diagnosis; vertebral osteomyelitis