824. Risk Factors for Lower Extremity Osteomyelitis in Solid Organ Transplant Recipients: a Case-control Study
Session: Poster Abstract Session: Bone and Joint
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • DFO txp poster- aligned.pdf (229.8 kB)
  • Background:   Osteomyelitis in association with diabetic foot ulcers is a common and serious infection.  Patients undergoing transplantation may face additional risk factors associated with immunosuppression  We undertook a study to examine risk factors for osteomyelitis in solid organ transplant (SOT) recipients.

    Methods:   Retrospective case-control study of 111 adult SOT recipients  diagnosed with osteomyelitis and 114 controls matched for type of transplant and duration of follow-up.  Adjusted odds ratios (aOR) for osteomyelitis following SOT were calculated using multiple logistic regression.  Variables included in the model were: age, sex, whether the patient was transplanted for diabetic nephropathy, maintenance immunosuppressive agents, acute rejection, Charlson scores, presence of hyperlipidemia, coronary artery disease, neuropathy, or trauma, and hemoglobin A1C level.

    Results: Most patients underwent kidney or kidney-pancreas transplantation for diabetic nephropathy.  The mean duration of follow-up was 52 months.  The vast majority of cases developed bacterial osteomyelitis of the foot. Independent risk factors for osteomyelitis in SOT recipients included: prednisone use (aOR 45.48, p=0.006), coronary artery disease (aOR 14.05, p<0.001), neuropathy (aOR 77.85, p<0.001), and higher hemoglobin A1C levels (aOR 1.36 for a one unit increase, p=0.032).  Factors that appeared protective included: tacrolimus use (aOR 0.19, p=0.012), antimetabolite use (aOR 0.14, p<0.001), and higher Charlson score (aOR 0.34, p<0.001).       

    Conclusion:   Risk factors for osteomyelitis in SOT recipients are largely similar to those previously described for non transplant patients with diabetes.  However, immunosuppressive agents have a differential effect on the risk for osteomyelitis. Confounding by indication is important to consider in this observational study and may explain the apparent paradoxical finding of decreased risk of osteomyelitis in SOT recipients with high Charlson scores.

    Meghan Brennan, MD1,2, Timothy Hess, PhD3, Jeaninna Smith, MD4, David Andes, MD4 and Nasia Safdar, MD, PhD3, (1)Medicine, University of Wisconsin, Madison, WI, (2)Medicine, William S. Middleton Memorial Veterans Hospital, Madison, WI, (3)Section of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, (4)University of Wisconsin, Madison, WI

    Disclosures:

    M. Brennan, William S. Middleton Memorial Advanced Fellowship in Women's Health Research : Employee, Salary

    T. Hess, None

    J. Smith, None

    D. Andes, None

    N. Safdar, None

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