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Predicting bacteremia and bacteremic mortality in liver transplant recipients
Author(s) -
Singh Nina,
Paterson David L.,
Gayowski Timothy,
Wagener Marilyn M.,
Marino Ignazio R.
Publication year - 2000
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.500060112
Subject(s) - bacteremia , medicine , gastroenterology , pneumonia , odds ratio , liver transplantation , sepsis , intensive care unit , surgery , antibiotics , transplantation , microbiology and biotechnology , biology
Predictors of bacteremia and mortality in bacteremic liver transplant recipients were prospectively assessed. One hundred eleven consecutive episodes of fever or infections were documented in 59 patients over a 4‐year period. Forty‐nine percent (29 of 59 patients) of the patients had bacteremia, 39% (23 of 59 patients) had nonbacteremic infections, and 12% (7 of 59 patients) had fever of noninfectious cause. Primary (catheter‐related) bacteremia (31%; 9 of 29 patients), pneumonia (24%; 7 of 29 patients), abdominal and/or biliary infections (14%; 4 of 29 patients), and wound infections (10%; 3 of 29 patients) were the predominant sources of bacteremia. Diabetes mellitus (odds ratio, 6.9; P = .03) and serum albumin level less than 3.0 mg/dL (odds ratio, 0.14; P = .02) were independently significant predictors of bacteremia compared with nonbacteremic infections. Mortality at 14 days was 28% (8 of 29 patients) in those with bacteremia compared with 4% (1 of 23 patients) in those with nonbacteremic infections and 0% (0 of 7) in patients with fever of noninfectious cause ( P = .03). Intensive care unit stay at the time of bacteremia (100% v 47%; P = .005), absence of chills (0% v 53%; P = .005), lower temperature at the onset of bacteremia (99.2°F v 101.5°F; P = .009), lower maximum temperature during the course of bacteremia (99.3°F v 102°F, P = .008), greater serum bilirubin level (7.6 v 1.5 mg/dL; P = .024), presence of abnormal blood pressure (80% v 16%; P = .0013), and greater prothrombin time (15.6 v 13.3 seconds; P = .013) were significantly predictive of greater mortality in the bacteremic patients. These data have implications for discerning the likelihood of bacteremia and initiation of empiric antibiotics pending cultures. Lack of febrile response in bacteremic liver transplant recipients portended a poorer outcome. (Liver Transpl 2000;6:54‐61.)