Risk factors, clinical features, and outcomes of listeriosis in solid-organ transplant recipients: a matched case-control study.

Abstract

BACKGROUND:

Solid-organ transplant (SOT) recipients are classically considered to be at increased risk for listeriosis. However, risk factors for this infection have not been assessed.

METHODS:

We carried out a multicenter, matched case-control study (1:2 ratio) from January 1995 through December 2007. Control subjects were matched for center, transplant type, and timing. Conditional logistic regression was performed to identify independent risk factors. Clinical features and outcomes for all case patients were reviewed.

RESULTS:

Thirty patients (0.12%) with cases of listeriosis were identified among 25,997 SOT recipients at 15 Spanish transplant centers. In a comparison of case patients with 60 matched control subjects, the following independent risk factors for listeriosis were identified: diabetes mellitus (odds ratio [OR], 5.6; 95% confidence interval [CI], 1.6-19.6; ), P = .007 history of cytomegalovirus infection or disease within the preceding 6 months (OR, 35.9; 95% CI, 2.1-620; P = .014), receipt of high-dose prednisone within the preceding 6 months (OR, 6.2; 95% CI, 1.8-21.1; P = .003), and trimethoprim-sulfamethoxazole (TMP-SMZ) prophylaxis (OR, 0.07; 95% CI, 0.006-0.76; P = .029). Twenty-six patients (86.7%) had bacteremia, and 7 had shock at presentation. Other manifestations included meningoencephalitis (10 cases), spontaneous peritonitis (2), pleural empyema (1), brain abscesses (1), and liver abscesses (1). The 30-day mortality rate was 26.7% (8 of 30 patients died).

CONCLUSIONS:

Listeriosis in SOT recipients is uncommon but causes high mortality. Diabetes mellitus, cytomegalovirus infection or disease, and receipt of high-dose steroids are independent risk factors for this infection, whereas TMP-SMZ prophylaxis is a protective factor.

• Authors: Núria Fernàndez-Sabé, Carlos Cervera, Francisco López-Medrano, Miguel Llano, Elena Sáez, Oscar Len, Jesús Fortún, Marino Blanes, Rosa Laporta, Julián Torre-Cisneros, Joan Gavaldà, Patricia Muñoz, M Carmen Fariñas, José María Aguado, Asunción Moreno, Jordi Carratalà
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 49 Issue 8 Pg. 1153-9 (Oct 15 2009) ISSN: 1537-6591 [Electronic] United States
• PMID: 19751149 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Steroids
• Trimethoprim, Sulfamethoxazole Drug Combination

Topics

• Adult
• Aged
• Case-Control Studies
• Cytomegalovirus Infections (complications)
• Diabetes Complications
• Female
• Humans
• Listeriosis (epidemiology, mortality, pathology, physiopathology)
• Male
• Middle Aged
• Risk Factors
• Steroids (adverse effects, therapeutic use)
• Transplants (adverse effects)
• Treatment Outcome
• Trimethoprim, Sulfamethoxazole Drug Combination (therapeutic use)
• Young Adult