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Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e3182310fb6
Original Studies

Risk Factors and Outcomes of Staphylococcus aureus Infections After Small Bowel and Multivisceral Transplantation

Florescu, Diana F. MD*; Qiu, Fang MS, PhD,; Vivekanandan, Renuga MD; Mercer, David F. MD§; Langnas, Alan N. DO§; Kalil, Andre C. MD*

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Background: No studies have evaluated the risk factors and outcomes of Staphylococcus aureus (SA) infections in small bowel (SBT) and multivisceral (including small bowel) transplantation (MVT).

Methods: SBT and MVT recipients with SA infections (22 cases) were retrospectively identified and compared with matched non–SA-infected recipient controls (44). The characteristics were compared with Friedman and Cochran-Mantel-Haenszel tests. Conditional logistic regression analysis was performed to identify risk factors, and Kaplan-Meier curve and Cox proportional hazard model were performed for survival analysis.

Results: The median age was 2.07 years (range, 0.76–54.04). Forty-three percent of the first SA infections were bloodstream infections, 30% lung infections, and 26% surgical site infections; 36% of these isolates were methicillin-resistant SA. Median time (days) to surgical site infections (41.0; range, 0–89) was significantly shorter than that to lung infections (266; range, 130–378) (P = 0.01). By univariate analysis, it was found that cases were more likely to have cytomegalovirus (CMV) sero-mismatch (odds ratio [OR] = 3.03 [95% confidence interval, 0.88–10.43]; P = 0.08), and controls were more likely to receive mycophenolate mofetil (MMF) treatment (0.09 [0.001–0.82]; P = 0.03). By multivariable analysis, patients with CMV sero-mismatch were found to have higher odds of developing SA infection (OR, 2.92; P = 0.085), whereas MMF had a protective effect (OR, 0.08; P = 0.031), adjusting for matched criteria. SA cases had shorter survival than controls (mean survival, 28.5 vs. 45.8 months [P = 0.04]) and were 2.18 times more likely to die (1.02–4.67, P = 0.04).

Conclusions: SA infections were associated with a significant shorter survival time and higher risk of death. The presence of CMV sero-mismatch and the absence of MMF treatment were found to be the risk factors for SA infections after SBT and MVT.

© 2012 Lippincott Williams & Wilkins, Inc.


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