Bacteremia in SOT Patients More Common Than Thought

SAN FRANCISCO—Bacteremia may be more common in solid organ transplant (SOT) recipients within the first nine months post-transplant than the current literature suggests, according to a new study presented at ID Week 2013.

 “Many people think we are out of the woods after that time,” said study investigator Kieren Marr, MD, a professor of medicine and oncology at Johns Hopkins Hospital in Baltimore, Md.  “Even 100 days out the risk is still high and it is still going higher. We need to look at their medicines more closely.”

She and her colleagues at Johns Hopkins University in Baltimore presented preliminary findings of the first 14 months of a prospective study that longitudinally captures the epidemiology, therapies, and outcomes in infection in SOT recipients.

Clinicians who manage SOT patients need standardized ways of evaluating prevention and treatment strategies, Dr. Marr said. Such standardization can provide important benefits in terms of selection of transplantation protocols. “We are troubled with fairly large bloodstream infectious rates in solid organ transplant patients,” she told Renal & Urology News. “They are higher than we thought they would be. We also found that a continued high rate of CMV [cytomegalovirus] disease when the patients are coming off their prophylaxis medicines. A large number of the patients who are getting these late bloodstream infections are kidney recipients.”

A total of 406 SOT patients—including 284 kidney transplant recipients—have now been enrolled in the study, which began on January 1, 2012. Bacteremia occurred in 13 (3.2%) of the 406 patients within the first nine months post-transplant. Nine of the 13 infections were in kidney recipients.

In the study by Dr. Marr and her collaborators, patients are being followed at three-month intervals. The researchers are collecting information relating to underlying disease, transplantation, infections, antimicrobials and complications by reviewing electronic medical records.  They are also contacting the patients directly and standardized definitions are used to code infectious outcomes.

The study provides a unique tool to capture infection outcomes using the latest diagnostic and prevention strategies in small and large subsets of transplant recipients, Dr. Marr said. Efforts are underway to expand this study to multiple centers because data derived from it may point to the optimal methods of preventing bloodstream infections and fungal infections in this immune compromised population. Studies such as the Multicenter AIDS Cohort study (MACS) have provided important outcome data on patients with HIV infection, she noted, adding that no such cohort studies have been performed in SOT recipients.

So far, investigators have identified four cases of candidiasis and one case aspergillosis in the SOT recipients; all of these infections occurred within three months of transplantation. In terms of bloodstream infections, it appears they may be occurring more than 100 days post-transplant in kidney recipients and greater efforts may be needed to prevent complicated urinary tract infections (UTIs) that are so common in these patients.

“We need to focus much more on preventing these complicated UTIs,” Dr. Marr said. “This is something that has been known but we wanted to present this abstract at this time because it is a very very powerful tool.  It allows for standard definitions for infections. We need more standardization.”

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