Background

Infection is the most common complication in intestinal transplant (IT) recipients. Data regarding the impact of infections on outcomes following IT is limited.

Methods

This is a retrospective chart review of all IT recipients between 2/2011 and 1/2014 in our hospital. Infection episode was defined as a continuous period of time with infection from one anatomic source and may include more than one pathogen. IDSA and CDC guidelines were used to define source of infection. Multidrug resistant (MDR) bacteria and extensively drug resistant (XDR) bacteria were defined per international guidelines.

Results

Our cohort included 25 IT recipients: small intestine + colon (20), multivisceral (4), and isolated small intestine (1). Median post-IT follow up was 12 months (mean 9.44 months). One-year patient survival was 68% (17/25). One-year graft survival (not censored for death) was 60% (15/25) and graft survival (censored for death) was 84% (21/25). One patient had an intra-operative death and was excluded from further analysis.

At least one infection episode was observed in 21/24 (87%) IT recipients with 1-3 episodes in 10 patients; 4-10 episodes in 6 and >10 episodes in 5. There were 118 total infection episodes: bacterial (75); fungal (12); bacterial + fungal (6); viral (13); unspecified (12). Overall there were 140 bacterial isolates and 25 fungal isolates. The most common sources of infection were intra-abdominal infection (41 episodes), respiratory tract infection (20), and central line associated bloodstream infection (18). The median interval from IT to any infection was 9 days (±50.5 days). The median intervals from IT to bacterial and fungal infections were 9.5 days (±32 days) and 36.5 days (±64.3 days), respectively. Infection episodes occurred most frequently during the first month after IT (26 episodes) and were mostly bacterial (20).

Mortality risk increased with each increase in the number of bacteria isolated [p 0.03; OR 1.2; 95% CI (1.0 – 1.5)]. Increased mortality risk was not associated with the number of infection episodes or number of fungal or viral isolates. Resistant bacteria were more frequently identified in the post-IT period compared to the pre-IT period but only XDR bacteria were associated with increased mortality [p 0.02; OR 6.9; 95% CI (1.3 – 37.0)].

Conclusions

Our data confirm that infections are frequent complications after IT and suggest that mortality is associated with complex infections marked by multiple bacterial isolates and resistance.

CITATION INFORMATION: Patel D, Shah H, Schiano T, Moon J, Iyer K, Huprikar S. Number of Bacterial Isolates and Resistance Increases Mortality Risk in Intestinal Transplant Patients. Am J Transplant. 2016;16 (suppl 3).

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