Infections and severe sepsis in solid-organ transplant patients admitted from a university-based ED

• Published in: The American journal of emergency medicine 2004-11, Vol.22 (7), p.530-533
• Main Authors: Trzeciak, Stephen, Sharer, Randall, Piper, Derek, Chan, Therese, Kessler, Chad, Dellinger, R.Phillip, Pursell, Kenneth J.
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Bacterial Infections - epidemiology; Biological and medical sciences; Clinical death. Palliative care. Organ gift and preservation; Critical Care - statistics & numerical data; Data collection; Emergency and intensive care: infection, septic shock; Emergency medical care; Emergency medical services; emergency medicine; Emergency service; Emergency Service, Hospital - statistics & numerical data; Female; Heart Transplantation - statistics & numerical data; hospital; Hospital Mortality; Hospitalization; Hospitals, Teaching; Hospitals, Urban; Humans; Incidence; infection; Infections; infectious diseases; Intensive care medicine; Kidney Transplantation - statistics & numerical data; Kidneys; Liver Transplantation - statistics & numerical data; Lung Transplantation - statistics & numerical data; Male; Medical sciences; Microbiology; Middle Aged; Mortality; Nosocomial infections; Pancreas Transplantation - statistics & numerical data; Patient Admission - statistics & numerical data; Pneumonia, Bacterial - epidemiology; Postoperative Complications - epidemiology; Retrospective Studies; Sepsis; Sepsis - epidemiology; severe sepsis; Teaching hospitals; transplantation; Transplants & implants; Transplants - statistics & numerical data; Urinary Tract Infections - epidemiology
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2004.09.010

The objective was to provide a descriptive analysis of infectious processes in transplant patients admitted from the emergency department (ED). A database of all adult transplant patients at a university medical center was cross-referenced with a computerized record of all ED visits over an 18-month period. ED charts, inpatient records, and microbiology data were retrospectively reviewed. Final diagnoses and outcomes were analyzed. There were 352 ED visits by transplant patients (kidney 66%, kidney/pancreas 15%, liver 13%, lung 3%, heart 3%). Infections were the most common indications for admission (77/217, 35%). Urinary tract infection and pneumonia were the most common infections. Nine of 77 patients (11.7%) with documented infections developed severe sepsis, which was the most common reason for ICU utilization. Thirty-five percent of transplant patients admitted from the ED had acute infections, and 11.7% of these patients had severe sepsis. The emergency physician must have a high index of suspicion for infections when evaluating organ transplant recipients.