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Bacteremias in liver transplant recipients: Shift toward gram‐negative bacteria as predominant pathogens
Author(s) -
Singh Nina,
Wagener Marilyn M.,
Obman Asia,
Cacciarelli Thomas V.,
de Vera Michael E.,
Gayowski Timothy
Publication year - 2004
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.20214
Subject(s) - klebsiella pneumoniae , medicine , pseudomonas aeruginosa , liver transplantation , microbiology and biotechnology , incidence (geometry) , staphylococcus aureus , bacteria , klebsiella , gram negative bacteria , transplantation , biology , escherichia coli , biochemistry , genetics , physics , optics , gene
During the 1990s, gram‐positive bacteria emerged as major pathogens after liver transplantation. We sought to determine whether the pathogens associated with bacteremias in liver transplant recipients have changed. Patients included 233 liver transplant recipients transplanted between 1989 and 2003. The proportion of all infections due to bacteremias increased significantly over time ( P < .0001). Of other major infections, a trend toward a decrease in fungal infections ( P = .089) and a significant decrease in cytomegalovirus (CMV) disease ( P = .0004) were documented. Whereas the proportion of bacteremias due to gram‐negatives increased from 25% in the period of 1989–1993 to 51.8% in 1998–03, that of gram‐positive bacteria decreased from 75% in the period of 1989–93 to 48.2% in the period of 1998–2003. Methicillin‐resistant Staphylococcus aureus (MRSA), Klebsiella pneumoniae , and Pseudomonas aeruginosa were the most frequent pathogens in bacteremic patients. The incidence of bacteremias due to MRSA and Pseudomonas aeruginosa has remained unchanged ( P < .20); however, that due to enteric gram‐negative bacteria, particularly Klebsiella pneumoniae has increased ( P = .02). Klebsiella pneumoniae isolates in the current quartile were not clonally related. In conclusion, bacteremias as a proportion of all infections in liver transplant recipients have increased significantly over time, due in part to a decline in infections due to other major pathogens, e.g., fungi, primarily Candida species, and CMV. Gram‐negative bacteria have emerged as predominant pathogens in bacteremic liver transplant recipients. (Liver Transpl 2004;10:844–849.)