Early-Onset and Late-Onset Bacteremias After Liver Transplantation

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BackgroundBacteremia is a significant cause of mortality after liver transplantation. The spectrum of pathogens and patterns of antibiotics susceptibility can vary owing to the variable local epidemiologic data and antibiotics modality. The aim of this study was to investigate bacteremic incidence, pathogenic spectrum, and clinical outcomes according to period after liver transplantation.MethodsWe retrospectively analyzed 393 subjects (267 male, 126 female) who had undergone liver transplantation from 2008 to 2015. Early-onset bacteremia was defined as bacteremia occurring within 6 months after liver transplantation, whereas bacteremia occurring beyond this period was classified as late-onset bacteremia.ResultsA total of 92 bacteremic patients with 156 episodes were identified. A total of 101 episodes of bacteremia occurred within 6 months after transplantation, among them, enterococcus spp. was the most common etiologic pathgen(n=27, 26.7%), followed by coagulase stapylococcus spp. (n=25, 24.8%), Acinetobacter spp. (n=15, 14.9%) and K. pnuemoniae (n=12, 11.9%). Among 55 late-onset bacteremia, Enteroccous spp. (n=11, 20.0%) and E. coli (n=11, 20.0%) was the most common pathogen, followed by Klebsiella spp. (n=10, 18.2%), Acinetobacter spp. (n=6, 10.9%). Gram positive cocci were more frequent as a pathogen of early onset bacteremia than late-onset bacteremia (n=59, 58.4% vs. n=20, 36.4%, p=0.031). As a source, catheter-related infection was a more common source of early-onset bacteremia (n=29, 29.0% vs. n=2, 3.6%), however, pneumonia (n=2, 2.0%, vs. n=8, 14.5%) was a more common source of late-onset bacteremia. Patients with early-onset bacteremia showed highest mortality compared with patients with late-onset bacteremia or nonbacteremia (31.3% [21/67] vs. 8.0% [2/25]. Vs. 10.0% [30/301]), p=0.0001). Among mortality cases, Enterococcus spp. (n=14) and Acinetobacter spp. (n=9) were most common pathogens.ConclusionMortality and sources of bacteremia were statistically significant different between early onset and late-onset bacteremia after transplantation. Our data showed different strategies are needed to reduce mortality after transplantation according to the post-transplant period.

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