Predicting bacteremia and bacteremic mortality in liver transplant recipients

Predictors of bacteremia and mortality in bacteremic liver transplant recip ients were prospectively assessed. One hundred eleven consecutive episodes of fever or infections were documented in 59 patients over a 4-year period. Forty-nine percent (29 of 59 patients) of the patients had bacteremia, 39% (23 of 59 patients) had nonbacteremic infections, and 12% (7 of 59 patient s) had fever of noninfectious cause, Primary (catheter-related) bacteremia (31%; 9 of 29 patients), pneumonia (24%; 7 of 29 patients), abdominal and/o r biliary infections (14%; 4 of 29 patients), and wound infections (10%; 3 of 29 patients) were the predominant sources of bacteremia. Diabetes mellit us (odds ratio, 6.9; P =.03) and serum albumin level less than 3.0 mg/dL (o dds ratio, 0.14; P = .02) were independently significant predictors of bact eremia compared with nonbacteremic infections, Mortality at 14 days was 28% (8 of 29 patients) in those with bacteremia compared with 4% (1 of 23 pati ents) in those with nonbacteremic infections and 0% (0 of 7) in patients wi th fever of noninfectious cause (P =.03). Intensive care unit stay at the t ime of bacteremia (100% v 47%; P =.005), absence of chills (0% v 53%; P =.0 05), lower temperature at the onset of bacteremia (39.2 degrees F v 101.5 d egrees F; P =.009), lower maximum temperature during the course of bacterem ia (99.3 degrees F v 102 degrees F; P =.008), greater serum bilirubin level (7.6 v 1.5 mg/dL; P =.024), presence of abnormal blood pressure (80% v 16% ; P =.0013), and greater prothrombin time (15.6 v 13.3 seconds; P =.013) we re significantly predictive of greater mortality in the bacteremic patients . These data have implications for discerning the likelihood of bacteremia and initiation of empiric antibiotics pending cultures. Lack of febrile res ponse in bacteremic liver transplant recipients portended a poorer outcome. Copyright (C) 2000 by the America Association for the Study of Liver Disea ses.