216. Bacterial Genotype and Clinical Outcomes in Solid Organ Transplant Recipients with Staphylococcus aureus Bacteremia
Authors: Eichenberger Emily , Ruffin Felicia , Sharma-Kuinkel Batu K , Dagher Michael M , Park Larry , Sinclair Matthew , Kohler Celia , Fowler Vance G , Maskarinec Stacey 
Published: December 2021

Abstract

Background
Solid organ transplant (SOT) recipients are characterized by extensive healthcare exposure and have high rates of Staphylococcus aureus bacteremia (SAB). The clinical characteristics and outcome determinants of SAB in this population are poorly understood. We undertook a prospective cohort study compared the bacterial genotype and clinical outcomes of SAB among SOT and non-solid organ transplant (non-SOT) recipients.

Methods
Consecutive patients presenting to our institution with SAB between January 1, 2016 and December 31, 2019 were eligible for study inclusion. Each subject’s initial S. aureus bloodstream isolate was genotyped using spa typing and assigned to clonal complexes using Ridom StaphType software.

Results
A total of 32 SOT and 634 non-SOT recipients with SAB were included. Bacterial genotype did not differ significantly between SOT and non-SOT recipients (p=0.4855), including the proportion of SAB caused by USA300 (12.5% vs 16.7%, p=0.6339). Ninety-day mortality and incidence of metastatic complications did not significantly differ between SOT and non-SOT recipients (18.8% vs 30.1%, p=0.2329, and 37.5% vs 48.6%, p=0.2769, respectively). Transplant status was significantly associated with septic shock (50.0% vs 21.8%, adjusted OR 2.63, 95% CI: 1.22 to 5.66). Infection with USA300 was not associated with 90-day mortality or septic shock among SOT recipients (p=1.0000 for both).
Staphylococcus aureus Genotype by Transplant Status

Conclusion
In conclusion, SOT recipients with SAB do not experience greater mortality than non-SOT recipients. Differences in genotype of the infecting bacteria do not appear to be a significant determinant of outcome in SOT recipients with SAB.

Disclosures
Vance G. Fowler, Jr., MD, MHS, Achaogen (Consultant)Advanced Liquid Logics (Grant/Research Support)Affinergy (Consultant, Grant/Research Support)Affinium (Consultant)Akagera (Consultant)Allergan (Grant/Research Support)Amphliphi Biosciences (Consultant)Aridis (Consultant)Armata (Consultant)Basilea (Consultant, Grant/Research Support)Bayer (Consultant)C3J (Consultant)Cerexa (Consultant, Other Financial or Material Support, Educational fees)Contrafect (Consultant, Grant/Research Support)Debiopharm (Consultant, Other Financial or Material Support, Educational fees)Destiny (Consultant)Durata (Consultant, Other Financial or Material Support, educational fees)Genentech (Consultant, Grant/Research Support)Green Cross (Other Financial or Material Support, Educational fees)Integrated Biotherapeutics (Consultant)Janssen (Consultant, Grant/Research Support)Karius (Grant/Research Support)Locus (Grant/Research Support)Medical Biosurfaces (Grant/Research Support)Medicines Co. (Consultant)MedImmune (Consultant, Grant/Research Support)Merck (Grant/Research Support)NIH (Grant/Research Support)Novadigm (Consultant)Novartis (Consultant, Grant/Research Support)Pfizer (Grant/Research Support)Regeneron (Consultant, Grant/Research Support)sepsis diagnostics (Other Financial or Material Support, Pending patent for host gene expression signature diagnostic for sepsis.)Tetraphase (Consultant)Theravance (Consultant, Grant/Research Support, Other Financial or Material Support, Educational fees)Trius (Consultant)UpToDate (Other Financial or Material Support, Royalties)Valanbio (Consultant, Other Financial or Material Support, Stock options)xBiotech (Consultant)