Death and kidney allograft dysfunction after bacteremia

Ito, Kenta; Goto, Norihiko; Futamura, Kenta; Okada, Manabu; Yamamoto, Takayuki; Tsujita, Makoto; Hiramitsu, Takahisa; Narumi, Shunji; Tominaga, Yoshihiro; Watarai, Yoshihiko

doi:10.1007/s10157-015-1155-6

Cited by 9 publications

(4 citation statements)

References 35 publications

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“…Bloodstream infection (BSI) frequently complicates the postoperative course and is the most frequent life-threatening infectious complication after abdominal solid organ transplantation (ASOT) [ 1 – 10 ]. The morbidity and mortality rates have been reported to range from 4.5-69% [ 2 , 11 – 22 ] and 2.4–52% [ 2 , 5 , 6 , 15 , 16 , 21 , 23 – 30 ] in ASOT recipients with BSI, respectively.…”

Section: Introductionmentioning

confidence: 99%

Factors influencing mortality in abdominal solid organ transplant recipients with multidrug-resistant gram-negative bacteremia

Qiao

Wan

et al. 2017

BMC Infect Dis

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BackgroundAlthough multidrug-resistant (MDR) gram-negative bacteremia (GNB) has been recognized as an important cause of morbidity and mortality among abdominal solid organ transplant (ASOT) recipients, there are no data on its prognostic factors after an interim standard definition of MDR was proposed in 2012. The objective of this study was to describe the epidemiology, microbiology, and predictors of infection-related 30-day mortality in ASOT recipients with MDR GNB.MethodsWe performed a retrospective, double-center analysis of ASOT patients with MDR GNB over a 13-year study period. Univariate and multivariate analyses were performed to identify the risk factors for mortality.ResultsDuring the observational period, 2169 subjects underwent ASOT. Ninety-nine episodes of MDR GNB were diagnosed in 91 (4.6%) ASOT recipients, with a predominance of E.coli (29 isolates, 29.3%) and A.baumanii (24 isolates, 24.2%). The median age of these 91 recipients was 45 years (interquartile range 35–54). Mortality after the first episode of MDR GNB was 39.6% (36 deaths). The univariate analysis identified the following variables as predictors of MDR GNB-related mortality: lung focus (P = 0.001),nosocomial origin (P = 0.002), graft from donation after cardiac death or deceased donors (P = 0.023), presence of other concomitant bloodstream infection (P < 0.001), temperature of 40 °C or greater at the onset of MDR GNB (P = 0.039), creatinine > 1.5 mg/dl (P = 0.006), albumin < 30 g/L (P = 0.009), platelet count < 50,000/mm3 (P < 0.001), and septic shock (P < 0.001). In the multivariate logistic regression analysis, septic shock (odds ratio (OR) = 160.463, 95% confidence interval (CI) = 19.377–1328.832, P < .001), as well as creatinine > 1.5 mg/dl (OR = 24.498, 95% CI = 3.449–173.998, P = 0.001), nosocomial origin (OR = 23.963, 95% CI = 1.285–46.991, P = 0.033), and presence of other concomitant bloodstream infections (OR = 27.074, 95% CI = 3.937–186.210, P = 0.001) were the variables associated with MDR GNB-related 30-day mortality.ConclusionsMDR GNB was associated with high morbidity and mortality in ASOT recipients, with a predominant causative organisms being E.coli and A.baumanii. Nosocomial origin, as well as presence of other concomitant bloodstream infections, increased creatinine level and septic shock were the main predictors of MDR GNB-related 30-day mortality.

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Section: Introductionmentioning

confidence: 99%

Factors influencing mortality in abdominal solid organ transplant recipients with multidrug-resistant gram-negative bacteremia

Qiao

Wan

et al. 2017

BMC Infect Dis

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“…Dysbiosis may lead to several post-transplantation complications such as the risk of infection (urinary tract infection, infectious diarrhea), adverse immunologic phenomena (autoimmune hemolytic anemia), graft rejection, and increased mortality rates. Selectively avoiding these alterations and inducing eubiotic changes in the peri-transplantation setting may hold preventative and therapeutic potential [10].…”

Section: Introductionmentioning

confidence: 99%

Impact of the Post-Transplant Period and Lifestyle Diseases on Human Gut Microbiota in Kidney Graft Recipients

Souai

Zidi

Mosbah³

et al. 2020

Microorganisms

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Gaining long-term graft function and patient life quality remain critical challenges following kidney transplantation. Advances in immunology, gnotobiotics, and culture-independent molecular techniques have provided growing insights into the complex relationship of the microbiome and the host. However, little is known about the over time-shift of the gut microbiota in the context of kidney transplantation and its impact on both graft and health stability. Here we aimed to characterize the structure of gut microbiota within stable kidney graft recipients. We enrolled forty kidney transplant patients after at least three months of transplantation and compared them to eighteen healthy controls. The overall microbial community structure of the kidney transplanted group was clearly different from control subjects. We found lower relative abundances of Actinobacteria, Bacteroidetes, and Verrucomicrobia within the patient group and a higher abundance of Proteobacteria compared to the control group. Both richness and Shannon diversity indexes were significantly lower in the kidney graft recipients than in healthy controls. Post-graft period was positively correlated with the relative abundance of the Proteobacteria phylum, especially Escherichia.Shigella genus. Interestingly, only Parabacteroides was found to significantly differentiate patients that were not suffering from lifestyle diseases and those who suffer from post-graft complications. Furthermore, network analysis showed that the occurrence of lifestyle diseases was significantly linked with a higher number of negative interactions of Sutterella and Succinivibrio genera within patients. This study characterizes gut microbiome fluctuation in stable kidney transplant patients after a long post-allograft period. Analysis of fecal microbiota could be useful for nephrologists as a new clinical tool that can improve kidney allograft monitoring and outcomes.

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“…Additionally, allograft survival, especially in the short‐term post‐transplant period, has significantly improved 1,2 . However, kidney transplant recipients (KTR) as immunocompromised hosts are at increased risk of infections 3 . Bloodstream infections (BSI), in particular, are a significant cause of morbidity and mortality in this population, 4 and KTRs have up to more than 40 times the annual rate of sepsis compared with the general population 5 .…”

Section: Introductionmentioning

confidence: 99%

Bloodstream infections by gram‐negative bacteria in kidney transplant patients: Incidence, risk factors, and outcome

Tsikala‐Vafea

Basoulis

Pavlopoulou

et al. 2020

Transplant Infectious Dis

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Over the last years, the number of kidney transplantations (KT) has increased, thus leading to an improvement in overall survival of patients with end-stage renal disease. 1 Additionally, allograft survival, especially in the short-term post-transplant period, has significantly improved. 1,2 However, kidney transplant recipients (KTR) as immunocompromised hosts are at increased risk of infections. 3

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Death and kidney allograft dysfunction after bacteremia

Abstract: Pneumonia in KTR should be managed with caution. Kidney function generally returned to baseline level after bacteremia. However, severe UTI may be associated with subsequent acute allograft rejection.

Cited by 9 publications

References 35 publications

Factors influencing mortality in abdominal solid organ transplant recipients with multidrug-resistant gram-negative bacteremia

Factors influencing mortality in abdominal solid organ transplant recipients with multidrug-resistant gram-negative bacteremia

Impact of the Post-Transplant Period and Lifestyle Diseases on Human Gut Microbiota in Kidney Graft Recipients

Bloodstream infections by gram‐negative bacteria in kidney transplant patients: Incidence, risk factors, and outcome

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