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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*

The Pediatric Infectious Disease Journal: January 2012 - Volume 31 - Issue 1 - p 25–29
doi: 10.1097/INF.0b013e3182310fb6
Original Studies

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.

From the *Infectious Diseases Section, University of Nebraska Medical Center, Omaha, NE; and Departments of †Biostatistics, ‡Internal Medicine, and §Transplant Surgery, University of Nebraska Medical Center, Omaha, NE.

Accepted for publication August 3, 2011.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Diana F. Florescu, MD, Transplant Infectious Diseases Program, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5400. E-mail: dflorescu@unmc.edu.

© 2012 Lippincott Williams & Wilkins, Inc.