Antibiotic prophylaxis lowers organ transplant associated-mortality rate

Almost 10% of solid organ transplant recipients (SOTr) may experience low mortality in the first year following transplantation due to bacteremia, says an article published in Open Forum Infectious Diseases. Dionysios Neofytos and his colleagues undertook this study in order to obtain comprehensive information on the epidemiology of bacteremia.

Researchers conducted a retrospective nested multi-center cohort analysis from 2008 to 2019 using the Swiss Transplant Cohort analysis registry to investigate the epidemiology of bacteremia in SOTr during the first year following transplant.

The key findings of this study were:

1. On a total of 4383 patients, 415 (9.5%) had 557 bacteremia caused by 627 bacteria.

2. For all, the heart, liver, lung, kidney, and renal-pancreas SOTr, the incidence was 9.5%, 12.8%, 11.4%, 9.8%, 8.3%, and 5.9%, respectively (P = 0.003).

3. During the research period, incidence dropped. Gram-negative bacilli (GNB), Gram-positive cocci (GPC), and Gram-positive bacilli (GPB) caused 5.62%, 2.81%, and 0.23% of cases of infection in one year, respectively.

4. 32/250 (12.8%) GNB generated extended-spectrum beta-lactamases, 2/67 (3%) enterococci were vancomycin-resistant, and seven (of 28, 25%) S. aureus isolates were methicillin-resistant.

5. Age, diabetes, cardiac disorders, surgical or medical post-transplant problems, rejection, and fungal infections were risk factors for developing bacteremia within a year of the transplant.

6. The presence of liver and lung transplants, rejection, surgical post-transplant problems, and dead donors were all risk factors for bacteremia in the first 30 days following transplantation. Cotrimoxazole Pneumocystis-prophylaxis, CMV donor-negative/recipient-negative serology, and transplantation between 2014 and 2019 all provided protection against bacteremia.

7. In SOTr with bacteremia, the 30-day mortality rate was 3% and did not vary by SOT type.

Since 2014 and in patients getting cotrimoxazole prophylaxis, lower bacteremia rates have been seen. Varying SOT types have varying incidence, timing, and pathogen distributions, which can be exploited to customize therapeutic and preventive measures.

Reference:

Neofytos, D., Stampf, S., Hoessly, L. D., D’Asaro, M., Nguyen Tang, G., Boggian, K., Hirzel, C., Khanna, N., Manuel, O., Mueller, N. J., Van Delden, C., Amico, P., Berishvili, E., … Berzigotti, A. (2023). Bacteremia during the first year after solid organ transplantation: an epidemiological update. In Open Forum Infectious Diseases. Oxford University Press (OUP). https://doi.org/10.1093/ofid/ofad247