engleski

Incidence, timing and aethyology of bloodstream infections following orthotopic liver transplantation or haematopoietic stem cell transplantation – a single center experience

Bloodstream infections (BSI) are major complications of orthotopic liver transplantation (OLT) and haematopoeitic stem cell transplantation (HSCT). Knowing characteristical timing of their occurrence enables anticipation of these infections and their earlier detection, and knowing the pattern of causative microorganisms is a prerequisite for determining suitable empirical therapy. Objective: to evaluate and compare incidence, timing and aetiology of BSI post transplantation (TX) in two groups (OLT and HSCT) of patients in a single institution. Methods: 263 consecutive TXs performed from Jan 2005 to Oct 2008 have been evaluated. OLT patients: n = 136 ; mean age 49 (range 16– 75, SD 12) ; HSCT patients: n = 126 ; mean age 45 (range 19– 70, SD 14) ; autologous TX 80.2%, allogeneic 19.8%. Patients were followed up 1 year after TX ; blood culture dates and isolates were recorded. Results: 78 BSI were identified (OLT: n = 42, HSCT: n = 36) at a median of 18 (range 1– 256, SD 75) days post TX (OLT: median 42, range 1– 248 SD 65 days ; HSCT: median 8, range 1– 256, SD 85 days, Mann Whitney p = 0.004). In both groups, the majority of BSI were observed in the first trimester following TX, in HSCT patients mostly (69.4% of all BSI in HSCT) during the first two weeks (Fig. 1). Gram-negative (GN) organisms were the prevalent cause (52.6%) of BSI in both groups, with Pseudomonas aeruginosa accounting for 16.7% of all BSI and 31.7% of all GN BSI. Gram-positive (GP) pathogens were responsible for 37.2% of BSI, with coagulase-negative staphylococci being the most prevalent in this group (17.9% of all pathogens, 48.3% of all GP organisms). Mixed BSI represented 3.8% and fungaemias (candidaemias) 6.4% of all BSI. No statistically significant differences in aetiology of BSI (GN, GP, fungal) were found between OLT and HSCT patients, neither during the whole period of observation (1 year), nor in any of the 4 trimesters. A trend towards higher incidence of fungaemia in OLT and allogeneic HSCT compared to autologous HSCT patients was revealed (Chi square, p = 0.09). Conclusions: BSI are frequent complications of both OLT and HSCT, especially during the first trimester post TX. In HSCT patients they occur significantly earlier than in OLT patients. Significant differences in aetiology of BSI between OLT and HSCT patients were not found, most BSI were caused by GN organisms in both groups. Empirical therapy in these immunosuppressed patients should include agents with strong antipseudomonal activity. Figure 1. Incidence of bloodstream infections in patients after haematopoietic stem cell transplantation (HSCT) or orthotopic liver transplantation (OLT).

haematopoietic stem cell transplantation; liver transplantation; bloodstream infections

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