Open AccessChanging trends in the aetiology, treatment and outcomes of bloodstream infection occurring in the first year after solid organ transplantation: a single‐centre prospective cohort study
Author(s) -
Oriol Isabel,
Sabé Núria,
Simonetti Antonella F.,
Lladó Laura,
Malles Anna,
González Jose,
Tubau Fe,
Carratalà Jordi
Publication year - 2017
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.12984
Subject(s) - medicine , bloodstream infection , etiology , pseudomonas aeruginosa , klebsiella pneumoniae , prospective cohort study , antibiotics , transplantation , microbiology and biotechnology , biochemistry , chemistry , genetics , escherichia coli , bacteria , gene , biology
Summary To analyse trends in the aetiology, treatment and outcomes of bloodstream infection ( BSI ) within the first year post‐transplant over the last 10‐year period, we prospectively recorded all episodes of BSI occurring in solid organ transplant ( SOT ) recipients during the first year post‐transplant from 2007 to 2016. Trends of factors were analysed by 2‐year periods. Of 475 consecutive episodes of BSI , 218 occurred within a year of SOT in 178 SOT recipients. Gram‐positive BSI decreased over time (40.5–2.2%). In contrast, there was a steady increase in Gram‐negative bacilli ( GNB ) BSI (54.1–93.3%; P < 0.001), mainly due to Pseudomonas aeruginosa (2.4–20.4%) and Klebsiella pneumoniae (7.1–26.5%). Multidrug‐resistant ( MDR ) GNB (4.8–38.8%; P < 0.001) rose dramatically, especially due to extended‐spectrum β‐lactamase ( ESBL ) production (7.1–34.7%). There was a sharp rise in the use of carbapenems, both as empirical (11.9–55.3%; P < 0.001) and as targeted antibiotic treatment (11.9–46.9%; P < 0.001). In conclusion, today, GNB are the leading causative agents of BSI in SOT recipients within the first year after SOT . In addition, MDR GNB have emerged mainly due to ESBL ‐producing strains. In spite of these changes, length of hospital stay, days of treatment and mortality have remained stable over time.