Bacterial Infections After Intestine and Multivisceral Transplantation C. Loinaz, T. Kato, S. Nishida, D. Weppler, D. Levi, L. Dowdy, J. Madariaga, J.R. Nery, R. Vianna, N. Mittal, and A. Tzakis ABSTRACT Background. The frequency of bacterial infections (BI) in intestinal transplant (IT) patients is high with sepsis being the leading cause of death after this procedure. We herein report our experience with major BI to ascertain the incidence, microbiological and clinical factors, risk factors and outcome. Materials and methods. 124 patients (72 children and 52 adults) received 135 grafts: namely, 39 isolated intestine, 33 liver–intestine and 63 multivisceral. Only major BI were considered, namely, those associated with serious morbidity/mortality requiring specific therapy. Patient data were retrieved from computerized databases, flow-charts, and medical records. Results. 92.7% patients showed BI. There were 327 episodes, representing 2.6 episodes/ patient (2.8/patients with infection): 193 episodes of bacteremia (1.7/patient with BI) including 29.5% due to catheter related sepsis, 16.5% from abdominal source, 5.7% from respiratory origin and 4.1% from the wound. The organ locations includes 46 respiratory infections, 33 intraabdominal abscesses or infected fluid collections, 8 diffuse peritonitis, 34 wound infections and other miscellaneous sites: empyema, soft tissue infections, cholan- gitis. . .etc. Median time of infection was nine days after surgery (mean 22  3 days), with 67.7% patients having at least one BI before the end of the first month. Infection was present in 76.2% of the 63 deceased patients. An infectious episode during month 1, a clinically manifest abdominal infection and a positive intraabdominal culture had negative impacts on patient survival. Conclusions. BI are common and early complications after IT. The high rate of bacteremia, line sepsis and abdominal and respiratory infections reflect the recipient’s condition, with chronic deterioration superimposed with the effects of prolonged abdom- inal visceral surgery. B ACTERIAL infections (BI) are frequent among intes- tinal transplant (IT) patients, and sepsis is the main cause of death. IT recipients need prolonged abdominal operations (usually with multiple anastomoses), heavy im- munosuppression and frequent access to the bloodstream for medication and nutrition. These conditions explain the high incidence of bacterial infections. We reviewed the major bacterial infections in intestinal transplantation (isolat- ed and combined with other organs) at the University of Miami/Jackson Memorial Hospital. We studied the incidence, microbiological and clinical factors related to these infections. MATERIALS AND METHODS All the IT performed at our institution from 1994 to the end of 2001 were included namely, 124 patients who received 135 grafts: 39 were isolated intestine, 33 liver–intestine, and 63 multivisceral. There were 72 children and 52 adults mean ages 3.41  0.46 years and 35.79  1.42 year, respectively. Mean follow-up was 535.3  58.12 days. Only major bacterial infections are considered namely, those associated with serious morbidity and mortality that required From the Division of Transplantation, University of Miami School of Medicine, Miami, Florida, USA. Visiting surgeon, (C.L.), 12 de Octubre Hospital,” Complutense University of Madrid, recipient of a Spanish FIS (Fondo de Investigaciones Sanitarias) grant (01/5014). Address reprint requests to A. Tzakis, Liver/GI Transplantation Service, UM/Jackson Memorial Hospital. 1801 NW 9th Av., 5th floor, Miami 33136, FL, USA. © 2003 by Elsevier Inc. All rights reserved. 0041-1345/03/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/S0041-1345(03)00728-0 Transplantation Proceedings, 35, 1929 –1930 (2003) 1929