Staphylococcus aureus infections after liver transplantation

• Published in: Infection Vol. 40; no. 3; pp. 263 - 269
• Main Authors: Florescu, D. F., McCartney, A. M., Qiu, F., Langnas, A. N., Botha, J., Mercer, D. F., Grant, W., Kalil, A. C.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.06.2012; Springer; Springer Nature B.V
• Subjects: Adolescent; Age; Bacteremia; Bacteremia - epidemiology; Bacteremia - microbiology; Biological and medical sciences; Case-Control Studies; Child; Clinical and Epidemiological Study; Cross Infection - epidemiology; Cross Infection - microbiology; Data processing; Drug resistance; Family Medicine; Female; General Practice; Hospitals; Humans; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - adverse effects; Infection; Infectious Diseases; Internal Medicine; Liver; Liver transplantation; Liver Transplantation - adverse effects; Logistic Models; Male; Medical sciences; Medicine; Medicine & Public Health; Methicillin-Resistant Staphylococcus aureus - isolation & purification; Middle Aged; Miscellaneous; Multivariate Analysis; Nebraska; Nosocomial infection; Postoperative Complications - epidemiology; Postoperative Complications - mortality; Public health. Hygiene; Public health. Hygiene-occupational medicine; Regression analysis; Retrospective Studies; Risk Factors; Staphylococcal Infections - epidemiology; Staphylococcal Infections - mortality; Staphylococcus aureus; Staphylococcus aureus - isolation & purification; Steroids - administration & dosage; Steroids - adverse effects; Surgery; Survival; Survival Analysis; Time Factors; Nebraska; Infection; Outcome; Risk factors; Liver transplantation; Nosocomial infection; Data analysis; Liver; Operation; Retrospective; Staphylococcus; Survey; Surgery; Risk factor; Bacteriosis; Bacteria; Micrococcales; Graft; Micrococcaceae; Hospital; Hygiene
• ISSN: 0300-8126; 1439-0973
• DOI: 10.1007/s15010-011-0224-3

Background More data on the risk factors and outcomes after Staphylococcus aureus infections in liver transplantation are needed. Methods Liver recipients with S. aureus infections (cases) were retrospectively identified and compared to gender-, age-, and transplant type-matched (1:2) non- S. aureus -infected controls. Risk factors associated with S. aureus infections were identified by conditional logistic regression analysis. Results We evaluated 51 patients (median age 52 years). First S. aureus infections developed at a median time of 29 days after transplantation, with 52.94% of them in the first month; 88.24% were nosocomial, 41.18% were polymicrobial, and 47.06% were caused by methicillin-resistant S. aureus (MRSA). Surgical site infections represented 58.82% and bacteremia 23.53%. By univariate analysis, patients with S. aureus infections were intubated more frequently (odds ratio [OR] 26.92, 95% confidence interval [CI] 3.23–3,504.15, p  = 0.0006), had a central line (OR 11.69, 95% CI 1.42–95.9, p  = 0.02), or recent surgery (OR 26.92, 95% CI 3.23–3,504.15, p  = 0.0006) compared with controls. By multivariate analysis, subjects who underwent surgery within 2 weeks prior to infection had a 26.9 times higher risk of developing S. aureus infection (95% CI 3.23–3,504.15, p  = 0.0006); these results were adjusted for matched criteria. S. aureus infections did not affect graft or patient survival, but the study was not powered for such outcomes. Conclusion Only recent surgical procedure was found to be a significant independent risk factor for S. aureus infections after liver transplantation.