Septic shock etiology in kidney transplant recipients

Introduction

Septic shock carries a high mortality in kidney transplant recipients. Therefore, early institution of empiric antimicrobial therapy is critical in the management of these patients. There are few data about septic shock etiology in kidney transplant recipients.

Objectives

The aim of this study is to determine the most common septic shock etiologic agents in kidney transplant recipients.

Setting

A kidney transplant specialized ICU in a 90-bed public hospital.

Methods

We prospectively followed (from May 2000 to December 2001) kidney transplant recipients admitted to ICU with diagnosis of septic shock according to SCCM/ACCP criteria. ICU resource utilization, microbiological identification and 28-day mortality were recorded. Apache II score for each patient was calculated within 24 hours of admission.

Results

We studied 14 (10 M/4 F) consecutive patients admitted to ICU with septic shock diagnosis. The mean age was 43 ± 9.5 years and mean Apache II was 23.7 ± 7.3. All patients were receiving immunosuppression therapy at ICU admission and 11 (78,5%) were in the first year of transplantation. The sources of infection were: lungs (n = 6), intra-abdominal (n = 4), endocarditis (n = 2), central venous catheter (n = 1) and central nervous system (n = 1). The most common isolated microorganisms were: Candida (n = 5), cytomegalovirus (n = 4), Staphylococcus aureus (n = 3), Acinetobacter baumanii (n = 2), Escherichia coli (n = 2), Pneumocystis carinii (n = 2), Klebsiella (n = 1) and Mycobacterium tuberculosis (n = 1). In only three (21%) patients just one agent was isolated and in another three (21%) patients we were not able to identify the etiologic agent. The mean length of ICU stay was 15 ± 15.7 days and of mechanical ventilation was 12.5 ± 16 days. In 10 (71%) of these patients a pulmonary artery catheter was inserted and there was need for renal replacement therapy in 13 (93%) patients. The 28-day mortality was 71% and overall ICU mortality was 78.5%.

Conclusions

Although kidney transplant recipients are susceptible to opportunistic infections due to immunosuppressive therapy, bacteria remain a frequent septic shock etiologic agent in these patients.