Jiandang Zhou

Mortality predictors of bloodstream infections in solid-organ transplant recipients.

OBJECTIVES Bloodstream infections are of great concerns and a major cause of mortality in solid-organ transplant recipients. This study investigated the possible predictors influencing survival among solid-organ transplant recipients with bloodstream infections. MATERIALS AND METHODS We performed a retrospective analysis of bloodstream infections in patients who underwent solid-organ transplant between January 2002 and November 2011. During the study, 133 episodes of bloodstream infections occurred in 98 solid-organ transplant recipients. The predictors were identified by univariate and multivariate logistic regression analyses. RESULTS The mean age for the 98 enrolled patients was 42.3 years (42.3 ± 12.8 y). The majority of infections were nosocomial (79.6%), and the bloodstream infection-related mortality rate was 39.8% (39 of 98 patients). The univariate analysis identified the following variables as predictors of bloodstream infection-related mortality: intra-abdominal/biliary focus (P = .011), polymicrobial infection (P < .001), liver transplant (P = .002), platelet count <50 000 × 109/L (P < .001), lymphocyte count <300 × 109/L (P = .027), and septic shock (P < .001). The multivariate logistic regression analysis identified platelet count < 50 000 × 109/L and septic shock as independent predictors of mortality. CONCLUSIONS The predictors significantly associated with increased mortality in solid-organ transplant recipients with bloodstream infections included decreased platelet count and septic shock. Even with appropriate antimicrobial therapy, bloodstream infections, accompanied by septic shock or decreased platelet count, are associated with high mortality rates. Therefore, steps must be taken to reduce the incidence of bloodstream infections in solid-organ transplant patients.

The Risk Factors for Mortality in Deceased Donor Liver Transplant Recipients With Bloodstream Infections

BACKGROUND Information on risk factors for mortality among deceased donor liver transplant recipients with bloodstream infections (BSIs) was sought using a retrospective analysis from January 2002 to January 2012. METHODS We performed deceased donor liver transplantations in 135 subjects who experienced 77 episodes of BSIs. We assessed risk factors for mortality among 43 of them using univariate and multivariate logistic regression analysis. RESULTS The 43 recipients (31.9%) who developed BSI showed a mean age of 45.1 (45.1 ± 14.1 years). The majority of infections were nosocomial in origin (97.7%), with more than half being polymicrobial (53.5%). There were 24 deaths among these recipients (55.8%). The univariate analysis identified the following variables as risk factors for BSI-related mortality: polymicrobial (P = .029), platelet count <50,000/mm(3) (P = .02), creatinine > 1.5 mg/dL (P = .008), and septic shock (P < .001). Multivariate logistic regression showed the independent risk factors for mortality to be a serum creatinine > 1.5 mg/dL and septic shock. CONCLUSION The risk factors significantly associated with increased mortality in deceased donor liver transplant recipients with BSIs are higher serum creatinine levels and septic shock. Despite appropriate antimicrobial treatment, BSIs accompanied by septic shock or higher serum creatinine levels were associated with high mortality rates. It is therefore essential to protect renal function to reduce the incidence of BSIs.

Frequency and clinical outcomes of ESKAPE bacteremia in solid organ transplantation and the risk factors for mortality

Although bacteremias caused by the 6 ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) have recently been highlighted as a serious complication in solid organ transplant (SOT), more information is urgently needed. We sought to investigate the frequency and clinical outcomes of ESKAPE bacteremia in SOT and determine the risk factors for mortality.

Acute respiratory distress syndrome in kidney transplant recipients.

Dear Editor, We retrospectively analyzed the microbiological spectrum and evaluated the factors associated with infection-related mortality in renal recipients with acute respiratory distress syndrome (ARDS) within 6 months after transplantation, according to the Berlin definition of ARDS [1], over the 10-year period from 2004 to 2014. Patient demographic and clinical data were collected, and laboratory data were collected at the onset of ARDS. During the study period, 1,369 patients underwent renal transplantation and 72 developed ARDS caused by pneumonia. The leading cause of end-stage renal disease was glomerulonephritis (58.3 %). Mean patient age was 39.2 years, and average duration between transplantation and ARDS onset was 97.5 days. The predominant causative agents were bacteria (73.8 %), cytomegalovirus (12.7 %), and fungi (7.9 %). Twentyeight and 11 patients had at least one acute rejection episode and one major infection before ARDS was diagnosed, respectively. Hepatitis B virus infection was found in 13.9 % of all these patients. Hospital mortality was 33.3 % overall. Ten (13.9 %) patients had mild, 38 (52.8 %) moderate, and 24 (33.3 %) severe ARDS; mortality was 4.2, 41.7, and 54.2 %, respectively (P = 0.005, Fig. 1). The independent determinants of mortality were use of tacrolimus [odds ratio (OR) 7.7 (95 % confidence interval, CI 1.5–38.4), P = 0.013], serum creatinine level [1.5 mg/dL [OR 5.8 (95 % CI 1.6–20.4), P = 0.006], and severe ARDS [OR 5.0 (95 % CI 1.5–17.1), P = 0.01] at onset of ARDS, as shown in Table S1. White blood cell (WBC) count \10,000/mm (P = 0.043), which was significantly associated with mortality on univariate analysis, did not however remain significant on multivariate analysis. The present study shows high incidence of ARDS (5.3 %) and mortality (33.3 %), in line with another study from China conducted by Tu et al. [2], who reported a mortality rate of 26.7 % in renal recipients with ARDS. We revealed that use of tacrolimus had 7.7-fold greater mortality than cyclosporine-based immunosuppression, in line with an earlier study [3] suggesting that tacrolimus was associated with a significantly higher percentage of Pneumocystis carinii and cytomegalovirus infections. We also identified increased serum creatinine as a 5.8-fold greater risk factor

Genetic Association of Interleukin-1β (−511C/T) and Its Receptor Antagonist (86-bpVNTR) Gene Polymorphism With Susceptibility to Bacteremia in Kidney Transplant Recipients

BACKGROUND Bacteremia remains a significant cause of morbidity and mortality after kidney transplantation. The present study was conducted to determine the influence of the polymorphisms of interleukin-1 β (IL-1 β) and IL-1 receptor antagonist gene (IL-1RN) on the susceptibility to bacteremia within the first year after kidney transplantation. METHODS Twenty-one bacteremic and 60 noninfected kidney transplant recipients, underwent extraction genomic DNA, from peripheral blood leukocytes. The region containing the AvaI polymorphic site at position -511 of 1L-I β gene was amplified by a polymerase chain reaction (PCR) and subsequently digested with AvaI restriction enzyme. The polymorphic regions within intron 2 of IL-1RN, containing variable numbers of a tandem repeat of 86 base pairs, were amplified by PCR. RESULTS We observed greater frequency of the IL-1 β -511CC genotype and IL-1 β -511C allele among bacteremic versus noninfected recipients (P = .023 and P = .015, respectively). In contrast, the current study failed to show significant difference, either in genotypic or allelic frequency, for the IL-1RN polymorphisms regarding the incidence of bacteremia (P = .508 and P = .507, respectively). After adjustment we observed recipient IL-1 β -511CC genotype (odds ratio [OR] = 4.400, 95% confidence interval [CI] = 1.517-12.759, P = .006) and recipient IL-1 β-511C allele (OR = 2.444, 95% Cl = 1.172-5.100, P = .015) to predict independently the risk for bacteremia within the first year after kidney transplantation. CONCLUSION The present work provided evidence that recipient IL-1 β -511CC genotype or IL-1 β -511C allele was associated with susceptibility to bacteremia within the first year after kidney transplantation. These results suggested that genotyping data may afford a more accurate prediction of bacteremia and the design of strategies to protect the most vulnerable patients.

Distribution and resistance of pathogens in liver transplant recipients with Acinetobacter baumannii infection.

Background Drug-resistant Acinetobacter baumannii has become a major problem in liver transplant recipients. The aim of this study was to investigate the clinical presentation, distribution, and drug susceptibility characteristics in liver recipients with A. baumannii infection. Methods We retrospectively investigated 17 liver recipients who developed A. baumannii infection between January 1, 2007 and December 31, 2014. The distribution of A. baumannii and drug susceptibility characteristics were reviewed. Results Infectious complications due to A. baumannii appeared in 17 liver recipients, with a total of 24 episodes. Approximately 63% (15/24) of A. baumannii infections occurred within 2 weeks after transplantation. The most common source of infection was multiple culture-positive sites (35.3%, n=6), followed by the intra-abdominal/biliary tract (23.5%, n=4) and lung (23.5%, n=4). Eight patients (47.1%) had a body temperature of 38°C or higher at the onset of A. baumannii infection. Nine, seven, and 12 recipients had a serum creatinine level of >1.5 mg/dL, a white blood cell count of >15,000/mm3, and a platelet count of <50,000/mm3, respectively. There were five (29.4%) cases of septic shock and eight (47.1%) deaths. The rate of antibiotic resistance of A. baumannii to ten of 12 antibiotics investigated was more than 60%. Among the 24 infections caused by A. baumannii, 75% were carbapenem-resistant. The rods were relatively sensitive to tigecycline and cefoperazone-sulbactam. Conclusion The clinical manifestations of A. baumannii infection included a high body temperature, a decreased platelet count, an elevated white blood cell count, and onset in the early period after transplantation as well as high mortality. The antibiotic resistance rate of A. baumannii was extremely high. Prevention measures and combination antibiotic therapy are needed to improve the outcomes of liver recipients with A. baumannii infections.

Mannose-binding lectin-2 and ficolin-2 gene polymorphisms and clinical risk factors for acute rejection in kidney transplantation.

INTRODUCTION There is growing evidence that the lectin pathway is significantly associated with acute rejection. Rare studies associated both gene polymorphisms of MBL2 and FCN2 with acute rejection after kidney transplantation. The aim of the present study was to investigate the role of the lectin gene profile and clinical risk factors such as PRA level on acute rejection in kidney transplant recipients. METHODS We prospectively analyzed 157 kidney transplant recipients with and without acute rejection. A total of 6 well-known functional single-nucleotide polymorphisms in the MBL2 gene and 5 in the FCN2 gene of the recipients were determined by gene sequencing. MBL2 and FCN2 genotypic variants were analyzed for association with the incidence of acute rejection within the first year after kidney transplantation. RESULTS After adjusting for variables of P<0.2, we found the differences in the incidence of acute rejection were only according to panel-reactive antibodies (odds ratios (OR) = 6.468, 95% confidence intervals (CI)= 2.017-20.740, P = 0.002) and the HH genotypes of MBL2 promoter -550 (OR = 2.448, 95%CI = 1.026-5.839, P = 0.044). CONCLUSION Panel-reactive antibodies and the HH genotypes of MBL2 promoter -550 have significant impacts on the risk of developing acute rejection after kidney transplantation.

Mortality predictors in recipients developing acute respiratory distress syndrome due to pneumonia after kidney transplantation

Abstract Background: The aim of the present study was to investigate the risk factors related to hospital mortality due to infection in kidney recipients with ARDS meeting the Berlin definition. Methods: Univariate and multivariate logistic regression analysis were used to confirm the independent risk factors related to infection-associated mortality. Results: From January 2001 to August 2014, a total of 94 recipients with acute respiratory dress syndrome (ARDS) caused by pneumonia following kidney transplantation were enrolled in the present study. The most common type of infection was bacterial (52/94; 55.3%), viral (25/94; 26.6%), and polymicrobial (14/94; 14.9%). The most common ARDS was diagnosed within 6 months after transplantation (76/94; 80.9%). There were 39 deaths in these recipients (39/94; 41.5%). Eleven (11.7%) patients had mild, 47 (50.0%) moderate, and 36 (38.3%) severe ARDS; mortality was 27.3, 27.7, and 63.9%, respectively. The independent predictors of infection-related mortality were serum creatinine level >1.5 mg/dL at ARDS onset (OR 3.5 (95%CI 1.2–10.1), p = 0.018) and severe ARDS (OR 3.6 (95%CI 1.4–9.7), p = 0.009) in the multivariate analysis. Conclusion: Infection-related mortality in kidney transplant patients with ARDS was associated with high serum creatinine level and severe ARDS.

Predictors of shock and mortality in solid organ transplant recipients with bacteremia caused by non-lactose-fermenting gram-negative bacilli

Background: More data on bacteremia due to non-lactose fermenting gram-negative bacilli (NLF GNB) in solid organ transplant (SOT) recipients are needed. We aimed to investigate the epidemiology, microbiology, and risk factors for mortality and septic shock due to NLF GNB bacteremia in SOT recipients. Methods: We performed a retrospective, double-center study over a 12-year study period. The risk factors for mortality and septic shock in SOT recipients with NLF GNB bacteremia were assessed with multivariate logistic regression analysis. Results: A total of 230 episodes of bloodstream infections (BSIs) occurred in 159 SOT recipients. Fifty episodes of NLF GNB bacteremia were detected in 47 SOT recipients, with a predominance of Acinetobacter baumanii (27 isolates, 54.0%). The antibiotic resistance rate of all NLF GNB to 10 of 12 antibiotics investigated was more than 50%. The independent risk factors associated with septic shock were platelet count < 50 000/mm3 (odds ratio (OR) = 14.41, 95% confidence interval (CI) = 2.64–78.71, p = 0.002) and late-onset bacteremia (time of onset more than 2 months post-transplant) (OR = 10.87, 95% CI = 1.79–65.89, p = 0.009). Lung focus (OR = 32.91, 95% CI = 2.56–423.18, p = 0.007) and septic shock (OR = 70.38, 95% CI = 4.21–1176.21, p = 0.003) were risk factors for bacteremia-related mortality. Conclusions: The drug resistance of the pathogens and the morbidity and mortality rates of NLF GNB bacteremia were high in SOT recipients. For septic shock, associated risk factors were thrombocytopenia and late-onset bacteremia. The risk factors significantly associated with mortality were lung focus and septic shock.

Predictors of Mortality in Abdominal Organ Transplant Recipients with Pseudomonas aeruginosa Infections.

BACKGROUND Pseudomonas aeruginosa infection remains a common life-threatening complication after abdominal organ transplantation. The objective of the present study was to determine epidemiology and predictors of mortality in abdominal organ transplant recipients with P. aeruginosa infections. MATERIAL AND METHODS A retrospective, double-center study was performed over a 12-year study period. The epidemiology of P. aeruginosa infections was investigated and the univariate and multivariate analyses were performed to identify the independent risk factors for crude and infection-related 30-day mortality in abdominal organ transplant recipients with P. aeruginosa infections. RESULTS In this study, 60 episodes of P. aeruginosa infection occurring in 54 abdominal organ transplant recipients were enrolled. Postoperative P. aeruginosa infection occurred in 54 (2.8%) of 1935 abdominal organ transplant recipients. Most episodes of P. aeruginosa infections were nosocomial (75.9%, n=41). Among those 54 patients, 30 (55.6%) developed pulmonary infection and 13 (24.1%) developed bacteremia. In 25 of the 54 (46.3%) patients, P. aeruginosa isolates were multidrug resistant. There were 6 (11.1%) cases of septic shock, 18 (33.3%) infection-related deaths, and 21 (38.9%) crude 30-day deaths. Septic shock (odds ratio (OR)=13.46, 95% confidence interval (CI)=1.43-126.38, P=0.023) was identified as an independent risk factor for infection-related 30-day mortality. The risk factors independently associated with crude 30-day mortality included P. aeruginosa or concomitant bacteremia (OR=6.79, 95% CI=1.82-25.39, P=0.004) and a serum creatinine level of ≥1.5 mg/dL (OR=4.62, 95% CI=1.11-19.16, P=0.035). CONCLUSIONS The morbidity and mortality rates of P. aeruginosa infections were appreciable in abdominal organ transplant recipients. P. aeruginosa or concomitant bacteremia and an elevated serum creatinine level were associated with higher crude mortality, and septic shock independently predicted higher infection-related mortality.