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Management of upper extremity Infections in the growing transplant population.
Aliotta RE, Said S, Bassiri B, Rampazzo A.
Cleveland Clinic Foundation
2018-02-12
Presenter: Aliotta, Rachel
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.
Director Name: Steven Bernard
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
HYPOTHESIS. As the length of lifetime survival after organ transplantation continues to increase, the consequences of long-term immunosuppression, such as opportunistic and rare infections, are increasingly encountered. This study examines upper extremity infections (UEI) in the transplant population to determine if atypical infections are more common, and whether transplant patients require higher rates of aggressive operative intervention or encounter worse outcomes.
METHODS. A large tertiary care institutional database of 16,640 transplant patients was queried for UEIs between 2005-2017, revealing 462 UEI patients (defined shoulder to fingertip). Intergroup analysis calculated using difference of means and ANOVA multivariate analysis (95% CI, P<0.01) at final analysis. A review of the literature was performed.
RESULTS.Preliminary data revealed a large cohort 56% male 44% female; comorbidities hypertension 76.1%, Diabetes mellitus 55.4%, Hyperlipidemia 58.7%. Most common, transplant: kidney (50%), liver (19.2%); site of upper extremity infection: forearm (32.7%), upper arm (22.1%), digit (22.1%); type of infection: cellulitis (82.7%), soft tissue abscess (30.8%), septic joint (6.7%), tenosynovitis (5.8%). When cultures collected (42.4%), most common bacteria isolated: staphylococcus aureus. Of entire group, 11.2% experienced multiple UEI's. Treatment with: medical IV antibiotics only (IVA, 70.4%), bedside procedure + IVA (15.4%), and operative intervention + IVA (11.2%). Infection resolved 91% patients with 1% UEI related-mortality, and 15.2% recurrence (same location 93%).
CONCLUSION. This is the largest examination of the management of UEI's in immunosuppressed transplant patients' reported to-date. Despite the fragile nature of the transplant patient, eradication of UEI's with aggressive antibiotic regimens reaches an acceptable rate with rare associated mortality.
