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Incidence Rate and Outcome of Gram-Negative Bloodstream Infection in Solid Organ Transplant Recipients
Article first published online: 6 MAR 2009
DOI: 10.1111/j.1600-6143.2009.02559.x
© 2009 The Authors Journal compilation © 2009 The American Society of Transplantation and the American Society of Transplant Surgeons
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How to Cite
Al-Hasan, M. N., Razonable, R. R., Eckel-Passow, J. E. and Baddour, L. M. (2009), Incidence Rate and Outcome of Gram-Negative Bloodstream Infection in Solid Organ Transplant Recipients. American Journal of Transplantation, 9: 835–843. doi: 10.1111/j.1600-6143.2009.02559.x
Publication History
- Issue published online: 26 MAR 2009
- Article first published online: 6 MAR 2009
- Received 17 September 2008, revised 04 December 2008 and accepted for publication 29 December 2008
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Keywords:
- Antibiotic resistance;
- bloodstream infection;
- epidemiology;
- mortality;
- solid organ transplantation
Bacterial infections are common complications of solid organ transplantation (SOT). In this study, we defined the incidence, mortality and in vitro antimicrobial resistance rates of Gram-negative bloodstream infection (BSI) in SOT recipients. We identified 223 patients who developed Gram-negative BSI among a cohort of 3367 SOT recipients who were prospectively followed at the Mayo Clinic (Rochester, MN) from January 1, 1996 to December 31, 2007. The highest incidence rate (IR) of Gram-negative BSI was observed within the first month following SOT (210.3/1000 person-years [95% confidence interval (CI): 159.3–268.3]), with a sharp decline to 25.7 (95% CI: 20.1–32.1) and 8.2 (95% CI: 6.7–10.0) per 1000 person-years between 2 and 12 months and more than 12 months following SOT, respectively. Kidney recipients were more likely to develop Gram-negative BSI after 12 months following transplantation than were liver recipients (10.3 [95% CI: 7.9–13.1] vs. 5.2 [95% CI: 3.1–7.8] per 1000 person-years). The overall unadjusted 28-day all-cause mortality of Gram-negative BSI was 4.9% and was lower in kidney than in liver recipients (1.6% vs. 13.2%, p < 0.001). We observed a linear trend of increasing resistance among Escherichia coli isolates to fluoroquinolone antibiotics from 0% to 44% (p = 0.002) throughout the study period. This increase in antimicrobial resistance may influence the choice of empiric therapy.