The objective of the study was to assess the incidence, risk factors, and survival of gram-positive bloodstream infections (GP-BSIs) among liver transplant recipients during the first year after transplantation. Between October 2000 and September 2006, 42 episodes of GP-BSIs occurred in 205 patients with an overall incidence of 0.20 episodes/patient. Coagulase-negative staphylococci were detected in 45.2% of cases, Enterococcus species in 42.9% (E faecalis, eight; E faecium, seven; E avium, two; E gallinarum, one) and Staphylococcus aureus in 11.9%. Retransplantation was the only independent risk factor for GP-BSI (odds ratio [OR], 0.253; 95% confidence interval (CI), 0.089 to 0.715; P = .009). Thirty-day mortality rate was 28.5% and S aureus infections were related to a poorer outcome. It is noteworthy that all the isolates of S aureus were methicillin-resistant. Ampicillin was inactive against all the strains of E faecium and 50% of E avium isolates, but active against all E faecalis and E gallinarum strains. All the isolates were glycopeptide-susceptible. No significant differences in mortality rate were observed in relation to sex, etiologies of end-stage liver disease, cytomegalovirus infection/reinfection, type of donor, rejection, or retransplantation. GP-BSI, the only independent risk factor for death (OR, 0.262; 95% CI, 0.106 to 0.643; P = .003), reduced the survival rate by 26% in the first year posttransplant. In conclusion, GP-BSIs impact significantly on morbidity and mortality posttransplant, particularly among retransplantations. Control measures are required to reduce the incidence of GP-BSIs in liver transplant recipients. These findings must be considered when empirical antimicrobial therapy is indicated while awaiting blood-culture results.

Gram-positive bloodstream infections in liver transplant recipients: incidence, risk factors, and impact on survival / A., Bedini; M., Codeluppi; S., Cocchi; Guaraldi, Giovanni; DI BENEDETTO, Fabrizio; C., Venturelli; Masetti, Michele; F., Prati; Mussini, Cristina; V., Borghi; Girardis, Massimo; Gerunda, Giorgio Enrico; F., Rumpianesi; Esposito, Roberto. - In: TRANSPLANTATION PROCEEDINGS. - ISSN 0041-1345. - STAMPA. - 39(2007), pp. 1947-1949. [10.1016/j.transproceed.2007.05.055]

Gram-positive bloodstream infections in liver transplant recipients: incidence, risk factors, and impact on survival.

GUARALDI, Giovanni;DI BENEDETTO, Fabrizio;MASETTI, Michele;MUSSINI, Cristina;GIRARDIS, Massimo;GERUNDA, Giorgio Enrico;ESPOSITO, Roberto
2007

Abstract

The objective of the study was to assess the incidence, risk factors, and survival of gram-positive bloodstream infections (GP-BSIs) among liver transplant recipients during the first year after transplantation. Between October 2000 and September 2006, 42 episodes of GP-BSIs occurred in 205 patients with an overall incidence of 0.20 episodes/patient. Coagulase-negative staphylococci were detected in 45.2% of cases, Enterococcus species in 42.9% (E faecalis, eight; E faecium, seven; E avium, two; E gallinarum, one) and Staphylococcus aureus in 11.9%. Retransplantation was the only independent risk factor for GP-BSI (odds ratio [OR], 0.253; 95% confidence interval (CI), 0.089 to 0.715; P = .009). Thirty-day mortality rate was 28.5% and S aureus infections were related to a poorer outcome. It is noteworthy that all the isolates of S aureus were methicillin-resistant. Ampicillin was inactive against all the strains of E faecium and 50% of E avium isolates, but active against all E faecalis and E gallinarum strains. All the isolates were glycopeptide-susceptible. No significant differences in mortality rate were observed in relation to sex, etiologies of end-stage liver disease, cytomegalovirus infection/reinfection, type of donor, rejection, or retransplantation. GP-BSI, the only independent risk factor for death (OR, 0.262; 95% CI, 0.106 to 0.643; P = .003), reduced the survival rate by 26% in the first year posttransplant. In conclusion, GP-BSIs impact significantly on morbidity and mortality posttransplant, particularly among retransplantations. Control measures are required to reduce the incidence of GP-BSIs in liver transplant recipients. These findings must be considered when empirical antimicrobial therapy is indicated while awaiting blood-culture results.
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Gram-positive bloodstream infections in liver transplant recipients: incidence, risk factors, and impact on survival / A., Bedini; M., Codeluppi; S., Cocchi; Guaraldi, Giovanni; DI BENEDETTO, Fabrizio; C., Venturelli; Masetti, Michele; F., Prati; Mussini, Cristina; V., Borghi; Girardis, Massimo; Gerunda, Giorgio Enrico; F., Rumpianesi; Esposito, Roberto. - In: TRANSPLANTATION PROCEEDINGS. - ISSN 0041-1345. - STAMPA. - 39(2007), pp. 1947-1949. [10.1016/j.transproceed.2007.05.055]
A., Bedini; M., Codeluppi; S., Cocchi; Guaraldi, Giovanni; DI BENEDETTO, Fabrizio; C., Venturelli; Masetti, Michele; F., Prati; Mussini, Cristina; V., Borghi; Girardis, Massimo; Gerunda, Giorgio Enrico; F., Rumpianesi; Esposito, Roberto
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/612939
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