Surgical Site Infection After Intestine Transplantation: Risk Factors and Outcomes.

IF 2.6 4区医学 Q3 IMMUNOLOGY

Transplant Infectious Disease Pub Date : 2025-07-01 DOI:10.1111/tid.70069

Mayyadah H Alabdely, Jessica Lum, Blanca E Gonzalez, Masato Fujiki, Zachary A Yetmar

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引用次数: 0

Abstract

Background: Infections are a significant complication of intestine transplantation. The epidemiology and impact of surgical site infections (SSIs) in this population are not well defined. This study aimed to investigate the incidence, risk factors, and outcomes of SSIs in intestine transplant recipients.

Methods: We conducted a retrospective cohort study of intestine transplant recipients at our institution from 2008-2022. SSIs were classified by CDC/NHSN criteria and evaluated in the first 30 days after transplantation. Multivariable Cox regression was used to evaluate risk factors for 30-day SSI and evaluate the association of SSI with death or allograft failure.

Results: Among 152 intestine transplant recipients, 55 (36.2%) patients developed 30-day SSI, with 50 (90.9%) being organ/space SSI. Enterococcus faecium (62.7%) and Candida species (49.0%) were the most common organisms, and multidrug-resistant organisms (68.6%) were common. Liver-inclusive transplantation, Charlson comorbidity index ≥2, and gastrointestinal leak were associated with SSI, while vancomycin-resistant Enterococcus-active perioperative prophylaxis and pre-transplant multidrug-resistant organism colonization were not. In adjusted analysis, SSI was associated with death or allograft failure (hazard ratio [HR] 1.71, 95% confidence interval [CI] 1.04-2.82; p = 0.036), particularly within 1 year of transplantation (HR 3.30, 95% CI 1.51-7.22, p = 0.003).

Conclusions: SSIs are frequent and severe complications following intestine transplantation, often involving multidrug-resistant organisms. SSIs appear mostly influenced by surgical factors and complications, with liver-intestine and multivisceral recipients at the highest risk. SSI was associated with poor long-term post-transplant outcomes, primarily within the first year. Strategies to mitigate these risks are needed.

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肠移植术后手术部位感染：危险因素和结果。

背景：感染是肠移植的重要并发症。手术部位感染（ssi）在这一人群中的流行病学和影响尚未明确。本研究旨在探讨肠移植受者ssi的发生率、危险因素和预后。方法：我们对2008-2022年在我院接受肠移植的患者进行了回顾性队列研究。根据CDC/NHSN标准对ssi进行分类，并在移植后的前30天进行评估。采用多变量Cox回归评估30天SSI的危险因素，并评估SSI与死亡或同种异体移植失败的关系。结果：152例肠移植受者中，55例（36.2%）发生30天SSI，其中50例（90.9%）发生器官/间隙SSI。以粪肠球菌（62.7%）和念珠菌（49.0%）最为常见，多药耐药菌（68.6%）最为常见。肝包涵移植、Charlson合并症指数≥2和胃肠道渗漏与SSI相关，而万古霉素耐药肠球菌活跃围手术期预防和移植前多药耐药菌定植与SSI无关。在校正分析中，SSI与死亡或同种异体移植失败相关(风险比[HR] 1.71, 95%可信区间[CI] 1.04-2.82；p = 0.036)，特别是在移植1年内（HR 3.30, 95% CI 1.51-7.22, p = 0.003）。结论：ssi是肠移植后常见且严重的并发症，常涉及多药耐药菌。ssi似乎主要受手术因素和并发症的影响，肝-肠和多内脏受体的风险最高。SSI与移植后不良的长期预后有关，主要是在第一年。减轻这些风险的战略是必要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplant Infectious Disease 医学-传染病学

CiteScore

5.30

自引率

7.70%

发文量

210

审稿时长

4-8 weeks

期刊介绍： Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.