ABSTRACT
BACKGROUND: Solid organ transplant recipients are susceptible to antibiotic-resistant infections and carbapenem-resistant Acinetobacter baumannii (CRAB) has recently been recognized as a serious complication in solid organ recipients. High mortality rates have been described. METHODS: We retrospectively analyzed 807 transplantations and detected 10 patients who died 24 hours after the diagnosis of septicemia, all with CRAB-positive blood cultures. Recipients were followed up for at least 1 year and were stratified into the following groups: Group 1, patients alive; Group 2, patients that died due to other causes except Acinetobacter infection; and Group 3, patients who died within 24 hours of CRAB diagnosis. RESULTS: CRAB-positive patients died a median of 3.17 (range, 1.81-18.7) months after transplantation. In these patients, expanded criteria donors (ECDs) were more frequent (P < .001), as were the use of anti-thymocyte globulin (ATG) induction (P = .02) and delayed graft function (P = .01). For ECD recipients, death rate from any cause, whether induced with ATG or not, was 25% and 20.6%, respectively (odds ratio [OR], 1.28; confidence interval [CI] 95%, 0.56-2.91; P = .68). The death rate from CRAB-related sepsis was 10.3% and 0% whether receiving ATG or not, respectively (OR, 15.49; CI 95%, 0.87-277.16; P = .014). There was a 25.75-fold increase in the death rate in ECD kidney recipients induced with thymoglobulin and with CRAB-related sepsis. CONCLUSION: Transplants from ECDs and induced with thymoglobulin may be at increased risk of CRAB death in 24 hours when compared with patients with standard donors and induced with thymoglobulin.
Subject(s)
Acinetobacter Infections/mortality , Antilymphocyte Serum/therapeutic use , Graft Rejection/prevention & control , Immunosuppressive Agents/therapeutic use , Kidney Transplantation , Pancreas Transplantation , Postoperative Complications/mortality , Sepsis/mortality , Acinetobacter Infections/microbiology , Acinetobacter baumannii , Adult , Brazil/epidemiology , Carbapenems , Delayed Graft Function/epidemiology , Disease Susceptibility , Donor Selection , Drug Resistance, Bacterial , Female , Humans , Male , Middle Aged , Odds Ratio , Postoperative Complications/microbiology , Retrospective Studies , Risk Factors , Sepsis/microbiology , Tissue DonorsABSTRACT
Acute graft pyelonephritis is a very common infection in renal transplantation. The impact of acute graft pyelonephritis (AGPN) on graft and patient outcome has not yet been established. Eight hundred seventy kidney and kidney-pancreas transplants were retrospectively studied, over last 13 years, to verify occurrence of AGPN in the first 30 days post-transplantation. We found that 112 patients (15.8%) presented post-transplantatiom AGPN up to 30 days after a kidney transplantation. The occurrence was higher in older patients (P = .005) and in those with ureteral stents (P = .06). Escherichia coli was the most frequent microorganism in urine cultures (32%). Ureteral stent (relative risk = 1.7; confidence interval [CI], 1.1-2.5; P = .018) was a major risk factor for AGPN as well as older ages (RR = 1.02; CI 1.01-1.04; P = .001), length of hospitalization stay (RR = 1.01; CI, 1.01-1.02; P < .001), and anti-thymocyte globulin (ATG) induction (RR = 1.6; CI, 1.022-2.561; P = .04). Long-term graft and patient survival was significantly lower in patients with pyelonephritis in the first 30 days after transplantation (OR 1.43; 95% CI, 0.95-2.16; P = .024 and OR 1.77; 95% CI, 1.12-2.80; P = .006, respectively). Acute pyelonephritis in the first 30 days after transplantation is therefore associated with a lower long-term graft and patient survival.
