Staphylococcus aureus infections in kidney transplantation

A matched case controlled study

Diana F Florescu, Fang Qiu, Sara Brostrom West, Sarah Richards, Marius C Florescu, Brian Stevens, Lisa Hill, Andre C Kalil

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Data are lacking on the risk factors and outcomes of Staphylococcus aureus infections in kidney transplant recipients. Methods: Kidney recipients with S. aureus infections (n = 20) were retrospectively identified and compared to age- and transplant-type-matched (1:2) non-S. aureus-infected controls (n = 40). Risk factors for S. aureus infections were identified by conditional logistic regression analysis. Results: Methicillin-resistant S. aureus (MRSA) was the cause of 32.1% of infections. Localizations of the infections were as follows: skin 42.9%, intra-abdominal 35.7%, blood stream 7.1%, and pulmonary 10.7%. The infections developed at a median time of 29 days (range 0358 days) after transplantation. By univariate analysis, variables significantly associated with infection were steroid administration 4 weeks prior to infection (odds ratio (OR) 4.2, 95% confidence interval (95% CI) 1.1-15.8; p = 0.03) and the presence of a central venous catheter 7 days prior to infection (OR 5.6, 95% CI 1.1-27.8; p = 0.03). By multivariate analysis, subjects with steroid treatment during the previous 4 weeks had a 6.13-times higher risk of developing S. aureus infection (95% CI 1.5-25.7; p = 0.01), and the risk of infection decreased by a factor of 0.65 for every 1-y increase in age (95% CI 0.44-0.97; p = 0.03); these results were adjusted for matched criteria. Post-infection outcomes (cases vs controls) included graft loss (10% vs 0%; p = 0.11) and 12-month mortality (0% vs 2.5%; p = 0.99). Conclusions: Younger age and steroid treatment were significant independent risk factors associated with S. aureus infections after kidney transplantation. Graft and patient survival were not affected, but the study was not powered for these outcomes.

Original languageEnglish (US)
Pages (from-to)427-432
Number of pages6
JournalScandinavian Journal of Infectious Diseases
Volume44
Issue number6
DOIs
StatePublished - Jun 1 2012

Fingerprint

Kidney Transplantation
Staphylococcus aureus
Infection
Confidence Intervals
Steroids
Odds Ratio
Transplants
Kidney
Central Venous Catheters
Graft Survival
Methicillin-Resistant Staphylococcus aureus
Multivariate Analysis
Transplantation
Logistic Models
Regression Analysis
Lung
Skin

Keywords

  • Kidney
  • Outcome
  • Risk factors
  • Staphylococcus aureus
  • Transplant

ASJC Scopus subject areas

  • Immunology and Microbiology(all)
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Staphylococcus aureus infections in kidney transplantation : A matched case controlled study. / Florescu, Diana F; Qiu, Fang; West, Sara Brostrom; Richards, Sarah; Florescu, Marius C; Stevens, Brian; Hill, Lisa; Kalil, Andre C.

In: Scandinavian Journal of Infectious Diseases, Vol. 44, No. 6, 01.06.2012, p. 427-432.

Research output: Contribution to journalArticle

Florescu, Diana F ; Qiu, Fang ; West, Sara Brostrom ; Richards, Sarah ; Florescu, Marius C ; Stevens, Brian ; Hill, Lisa ; Kalil, Andre C. / Staphylococcus aureus infections in kidney transplantation : A matched case controlled study. In: Scandinavian Journal of Infectious Diseases. 2012 ; Vol. 44, No. 6. pp. 427-432.
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AB - Background: Data are lacking on the risk factors and outcomes of Staphylococcus aureus infections in kidney transplant recipients. Methods: Kidney recipients with S. aureus infections (n = 20) were retrospectively identified and compared to age- and transplant-type-matched (1:2) non-S. aureus-infected controls (n = 40). Risk factors for S. aureus infections were identified by conditional logistic regression analysis. Results: Methicillin-resistant S. aureus (MRSA) was the cause of 32.1% of infections. Localizations of the infections were as follows: skin 42.9%, intra-abdominal 35.7%, blood stream 7.1%, and pulmonary 10.7%. The infections developed at a median time of 29 days (range 0358 days) after transplantation. By univariate analysis, variables significantly associated with infection were steroid administration 4 weeks prior to infection (odds ratio (OR) 4.2, 95% confidence interval (95% CI) 1.1-15.8; p = 0.03) and the presence of a central venous catheter 7 days prior to infection (OR 5.6, 95% CI 1.1-27.8; p = 0.03). By multivariate analysis, subjects with steroid treatment during the previous 4 weeks had a 6.13-times higher risk of developing S. aureus infection (95% CI 1.5-25.7; p = 0.01), and the risk of infection decreased by a factor of 0.65 for every 1-y increase in age (95% CI 0.44-0.97; p = 0.03); these results were adjusted for matched criteria. Post-infection outcomes (cases vs controls) included graft loss (10% vs 0%; p = 0.11) and 12-month mortality (0% vs 2.5%; p = 0.99). Conclusions: Younger age and steroid treatment were significant independent risk factors associated with S. aureus infections after kidney transplantation. Graft and patient survival were not affected, but the study was not powered for these outcomes.

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