Background: Irreversible intestinal failure can be treated effectively with intestinal transplant (ITx). Infections are common after ITx but data on bloodstream infection (BSI) due to enteric organisms is scarce.

Methods: Retrospective study of adults who underwent ITx from 1/2009 to 5/2017 at Jackson Memorial Hospital. Number of BSI episodes due to enteric organisms during the first 6 months after ITx were obtained. Sources and median time from ITx to onset of BSI were evaluated. BSI was considered to be caused by gut translocation if no other sources were found and the bowel biopsy showed rejection or enteritis. Presence of rejection within 2 weeks prior or after BSI was investigated. We assessed if there was a difference in the 6-month post-transplant survival between patients who developed BSI and those who did not.

Results: 60 adults underwent ITx (3 of whom died during the transplant surgery and were excluded). 57 patients were analyzed (isolated=24, multi-visceral=24 and modified multi-visceral=9). Male: 21 (37%); median age: 46 years (18-68 years). 28 (49%) patients developed a total of 51 episodes of BSI (mean episodes per patient: 1.7±0.9). Median time from transplant to BSI: 84 days (2-180 days). The organisms were K. pneumoniae, 17 (33%), Enterococcus spp., 16 (31%), Candida spp., 9 (18%), E. cloacae, E. coli and Bacteroides spp., 2 (4%) each, and Clostridium spp., P. mirabilis and Lactobacillus spp., 1 (2%) each. 23 (45%) were multi-drug resistant [vancomycin-resistant E. faecium (13) and E. faecalis (1), K. pneumoniae carbapenemase-producer (3), extended-spectrum β-lactamase K. pneumoniae (5) and E. coli (1)]. The sources were gut translocation, 18 (35%), line infection, 10 (20%), intra-abdominal abscess, 7 (14%), pneumonia and UTI, 2 (4%) each, pancreatitis, peritonitis and mycotic aneurysm, 1 (2%) each and unclear, 9 (18%). BSI episodes were associated with rejection in 16 (31%), (mild acute cellular rejection=6, moderate=4, severe 3 and antibody-mediated rejection=3). There was no difference in 6-month post-transplant survival among those who developed BSI compared to those who did not, 22 (79%) vs. 26 (90%), P=0.3.

Conclusions: Half of our patients developed BSI (typically during the first 3 months). Gut translocation was the most common source of BSI. Patients with rejection and/or enteritis should be monitored closely for BSI.

CITATION INFORMATION: Simkins J., Morillas-Rodriguez J., Morris M., Abbo L., Camargo J., Vianna R. Bloodstream Infection Caused by Enteric Organisms during the First 6 Months after Intestinal Transplant Am J Transplant. 2017;17 (suppl 3).

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