1519. Epidemiology and Risk Factors for Primary Bloodstream Infections (pBSI) in Solid Organ Transplant Recipients
Session: Poster Abstract Session: Infections and Transplantation
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • 41768_IDWPOSTER.pdf (266.9 kB)
  • Background: Because bacteremia is a major cause of morbidity and mortality among solid organ transplant recipients, the aim of this study was to describe the epidemiology and risk factors for pBSI during transplant-related admissions.

    Methods: Retrospective evaluation of all solid organ transplant admissions at NewYork-Presbyterian Hospital between 2006-2008.  Patients without immunosuppressive medication (ISM) records or >1 transplant were excluded.  pBSI were defined as central line-associated BSI or BSI without another known source.

    Results: A total of 1,615 transplant recipients were evaluated: 222 heart transplant (HT), 132 lung transplant (LGT), 330 liver transplant (LT), 928 renal transplant (RT), and 3 intestinal transplant (IT). Overall, 108 episodes of pBSI (28 HT, 3 LGT, 58 LT, 14 RT, 5 IT) occurred in 88 patients.  Incidence rates of pBSI ranged from 1.23/1000 patient days for LGT to 17.36/1000 patient days for IT.  Median time from all transplants to pBSI was 8 days (IQR 4,19); median time to pBSI was similar between groups (p=0.25). Most common pathogens were coagulase-negative Staphylococcus, Enterococcus species (spp), and Klebsiella spp.  46 (43%) episodes of pBSI were due to resistant isolates.  Overall crude mortality was 24%. Risk factors for HT, LT, and RT recipients included: HT – intubation (OR=19.6, 95%CI=6.0, 63.7) and rejection (OR=4.7, 95%CI=1.6, 13.9); LT – hospitalization within the past 30 days (OR=2.8, 95%CI=1.2, 6.7), intubation (OR=9.5 95%CI=4.1, 22.1), ≥2 major diagnostic procedures (OR=5.7, 95%CI=1.1, 29.4), and ≥2 major therapeutic procedures (OR=2.3, 95%CI=1.0, 5.1); RT – hospitalization within the past 30 days (OR=10.1, 95%CI=1.7, 60.9), intubation (OR=6.9, 95%CI=1.9, 25.8), ≥2 major therapeutic procedures (OR=6.0, 95%CI=1.3, 26.2), rejection (OR=8.0, 95%CI=1.8, 35.8), and receipt of mammalian target of rapamycin inhibitors (OR=5.6, 95%CI=1.5, 20.7).

    Conclusion: pBSI are a major concern during solid organ transplant admissions and inpatient procedures appear to pose significant risk for pBSI.  Stringent infection control practices, especially in procedural areas, are required to reduce morbidity and mortality related to pBSI following solid organ transplantation.

    Stephanie Pouch, MD, Infectious Diseases, Columbia University Medical Center, New York, NY; NewYork-Presbyterian Hospital, New York, NY, Jianfang Liu, MS, PhD, Columbia University School of Nursing, New York, NY and Elaine Larson, PhD, RN, FIDSA, FSHEA, School of Nursing, Columbia University Medical Center, New York, NY

    Disclosures:

    S. Pouch, None

    J. Liu, None

    E. Larson, None

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