Table 3.
Results of Multivariable Analyses to Identify Risk Factors for Bloodstream Infections During the First Year Post-transplant: (A) Overall, (B) Very Early (0–30 Days) vs Later; for the Purposes of Those Analyses, Kidney-Pancreas Transplant Recipients Were Considered With Kidney Transplant Recipients, due to the Small Number of Kidney-Pancreas Transplants
| Overall | Very Early BSIa | |||||
|---|---|---|---|---|---|---|
| HR | 95% CI | P | HR | 95% CI | P | |
| Demographics recipient/donor | ||||||
| Recipient age, 10 y | 1.16 | 1.05–1.29 | 0.003 | 0.99 | 0.86–1.14 | 0.9 |
| Recipient sex, male vs female | 0.86 | 0.69–1.08 | .2 | … | … | … |
| Donor age, 10 y | 1.05 | 0.98–1.12 | .14 | 1.03 | 0.93–1.13 | .6 |
| Baseline comorbidities | ||||||
| Diabetes mellitus, yes vs no | 1.42 | 1.12–1.8 | .004 | 1.33 | 0.92–1.91 | .18 |
| Hypertension, yes vs no | 1.05 | 0.81–1.35 | .7 | 0.98 | 0.67–1.45 | >.9 |
| Cardiopulmonary disease, yes vs no | 1.39 | 1.09–1.77 | .007 | 1.21 | 0.83–1.77 | .3 |
| Malignancy, yes vs no | 0.79 | 0.6–1.06 | .12 | … | … | … |
| Transplant-related variables | ||||||
| Donor status, deceased vs living | 1.28 | 0.94–1.74 | .11 | 1.88 | 1.02–3.44 | .04 |
| Transplant year, 2014–2019 vs 2009–2013 | 0.66 | 0.54–0.82 | <.001 | 0.73 | 0.53–1.01 | .05 |
| Induction immunosuppression, Thymoglobulin vs other | 0.98 | 0.73–1.32 | >.9 | 1.28 | 0.8–2.07 | .3 |
| CMV serology status, D-/R- vs R+ | 0.62 | 0.46–0.86 | .003 | 0.57 | 0.35–0.94 | .03 |
| CMV serology status, D+/R- vs R+ | 1.04 | 0.8–1.34 | .8 | 0.9 | 0.6–1.35 | .6 |
| Transplant type (compared with kidney) | ||||||
| Heart | 1.1 | 0.72–1.67 | .7 | 1.54 | 0.85–2.81 | .2 |
| Liver | 0.98 | 0.69–1.39 | >.9 | 1.52 | 0.9–2.56 | .11 |
| Lungs | 1.02 | 0.68–1.53 | >.9 | 2.65 | 1.5–4.67 | <.001 |
| Post-transplant time-dependent variables | ||||||
| Surgical complications,b yes vs no | 3.09 | 2.21–4.33 | <.001 | 2.4 | 1.59–3.61 | <.001 |
| Medical complications,c yes vs no | 2.27 | 1.3–3.98 | .004 | … | … | … |
| Rejection,d yes vs no | 2.37 | 1.76–3.19 | <.001 | 2.77 | 1.66–4.63 | <.001 |
| Invasive fungal infection,d yes vs no | 3.14 | 1.57–6.27 | .001 | … | … | … |
| Any viral infection (excluding CMV),d yes vs no | 1.08 | 0.39–2.96 | .9 | … | … | … |
| CMV infection,d yes vs no | 1.8 | 0.66–4.87 | .2 | … | … | … |
| Administration of TMP/SMX as prophylaxis, yes vs no | 0.5 | 0.38–0.65 | <.001 | 0.4 | 0.27–0.6 | <.001 |
Abbreviations: BSI, bloodstream infection; CMV, cytomegalovirus; D/R, donor/recipient; HR, hazard ratio; TMP/SMX, trimethoprim/sulfamethoxazole.
Due to the limited number of BSI events during the first month post-transplant, a smaller number of independent variables was considered based on clinical plausibility and available literature data, excluding the following variables from this model: malignancy before transplant, post-transplant medical complications, invasive fungal infections, and viral infections.
Surgical post-transplant complications within 30 days of BSI included vascular, anastomosis, biopsy, bleeding, and surgical site complications.
Medical transplant-related complications within 1 year of BSI included diabetes mellitus, hypertension, metabolic disorders, cardiopulmonary disease, transplanted organ tumor, and/or primary disease recurrence.
Rejection and invasive fungal or viral/CMV infections were considered within 90 days of BSI.