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. 2022 Dec;22(12):3031-3046.
doi: 10.1111/ajt.17184. Epub 2022 Sep 24.

Epidemiology and outcomes of bone and joint infections in solid organ transplant recipients

Truong-Thanh Pham  1   2 , Diego O Andrey  1 , Susanne Stampf  3 , Sara H Burkhard  4 , Cédric Hirzel  5 , Johnathan Tschopp  6 , Kathrin Ullrich  7 , Carol Strahm  8 , Peter W Schreiber  4 , Noémie Boillat-Blanco  6 , Christian Garzoni  9 , Nina Khanna  7 , Oriol Manuel  6   10 , Nicolas J Mueller  4 , Domizio Suva  2 , Christian van Delden  1   11 , Ilker Uçkay  12 , Dionysios Neofytos  1   11 ; Swiss Transplant Cohort Study
Collaborators, Affiliations

Epidemiology and outcomes of bone and joint infections in solid organ transplant recipients

Truong-Thanh Pham et al. Am J Transplant. 2022 Dec.

Abstract

Bone and joint infection (BJI) epidemiology and outcomes in solid organ transplant recipients (SOTr) remain largely unknown. We aim to describe BJI in a multi-center cohort of SOTr (Swiss Transplant Cohort Study). All consecutive SOTr with BJI (01.05.2008-31.12.2019) were included. A nested case-control study to identify risk factors for BJI was performed. Among 4482 patients, 61 SOTr with 82 BJI were included, at an incidence of 1.4% (95% CI 1.1-1.7), higher in heart and kidney-pancreas SOTr (Gray's test p < .01). Although BJI were predominately late events (median of 18.5 months post-SOT), most infections occurred during the first year post-transplant in thoracic SOTr. Diabetic foot osteomyelitis was the most frequent infection (38/82, 46.3%), followed by non-vertebral osteomyelitis (26/82, 31.7%). Pathogens included Gram-positive cocci (70/131, 53.4%), Gram-negative bacilli (34/131, 26.0%), and fungi (9/131, 6.9%). BJI predictors included male gender (OR 2.94, 95% CI 1.26-6.89) and diabetes (OR 2.97, 95% CI 1.34-6.56). Treatment failure was observed in 25.9% (21/81) patients and 1-year mortality post-BJI diagnosis was 14.8% (9/61). BJI remain a rare event in SOTr, associated with subtle clinical presentations, high morbidity and relapses, requiring additional studies in the future.

Keywords: BJI; bone and joint infection; epidemiology; solid organ transplant recipients.

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Figures

FIGURE 1
FIGURE 1
Cumulative incidence of bone and joint infection among solid organ transplant recipients: (A) overall and (B) by organ transplanted. Time to infection by organ transplant categories (C). [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 2
FIGURE 2
Distribution of bone and joint infections (A) and pathogens (B), by organ transplanted. [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 3
FIGURE 3
Presentation of bone and joint infection treatments, based on (A) antimicrobial treatments administered and (B) surgical procedure. [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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