Infection with Two Multi-Drug–Resistant Organisms in Solid Organ Transplant Patients Is Associated with Increased Mortality and Prolonged Hospitalization

Abstract

Background:

Solid organ transplant recipients have several risk factors for peri-operative multi-drug–resistant infection: their immune system is dampened as a result of critical illness and surgical stress that may be further impaired by induction immunotherapy and broad-spectrum antibiotic prophylaxis promotes selection for resistant pathogens. Infection with multi-drug–resistant organisms (MDRO) results in morbidity and mortality for solid organ transplant recipients.

Patients and Methods:

To assess in-hospital mortality and hospitalization duration associated with these infections, we analyzed cross-sectional, retrospective data from the 2016 Agency for Healthcare and Quality, Healthcare Cost and Utilization Project's National Inpatient Sample. Our analysis included 31,105 index admissions records for liver, kidney, heart, lung, and pancreas transplant recipients in the United States. Outcomes were assessed by multivariable regression analysis adjusting for covariables.

Results:

One percent (355/29,451) of patients with diagnosis of no MDRO infections died, 3% (40/1491) with diagnosis of one MDRO infection died, and 15% (25/166) with diagnosis of two MDRO infections died. Diagnosis of one MDRO infection was associated with a 20-day increase in hospitalization duration (95% confidence interval [CI], 17–22) but not increased odds of death (odds ratio [OR], 1.2; 95% CI, 0.5–2.5). Diagnosis of two MDRO infections was associated with an increased odds of death (OR, 9.6′ 95% CI, 3.3–27.9) and a 41-day increase in hospitalization duration (95% CI, 34–49).

Conclusions:

Strategies to decrease peri-operative MDRO infection may improve survival and decrease duration of hospitalization for solid organ transplant patients.