P1136 - A 13-Year Nationwide Analysis of Nocardia and Actinomyces Infection Outcomes in Liver Transplant Recipients

James R. Pellegrini, MD¹, Andrej Sodoma, DO², Rezwan Munshi, MD³, Sonika Rathi, MS⁴, Samuel Greenberg, BA⁵, Tulika Saggar, MD⁶, Atul Sinha, MD⁶, Jiten Desai, MD⁶, Paul Mustacchia, MD, MBA⁶, Ana P. Rivera, MD^7
1Nassau University Medical Center, Great River, NY; ²South Shore University Hospital, Bay Shore, NY; ³MercyOne North Iowa Medical Center, Mason City, IA; ⁴New York Institute of Technology College of Osteopathic Medicine, Smithtown, NY; ⁵Renaissance School of Medicine at Stony Brook University, Stony Brook, NY; ⁶Nassau University Medical Center, East Meadow, NY; ⁷Nassau University Medical Center, Amityville, NY

Introduction:

Liver transplant (LT) recipients have a profound susceptibility to infections. Although Nocardia and Actinomyces (NA) are well-known bacteria that typically affect immunosuppressed patients, a scarcity of research exists on the effects of LT with NA infections. Our study aims to evaluate the outcomes associated with NA infections in LT patients.

Methods: Patients were selected from the National Inpatient Sample (NIS) from 2008 through 2020. International Classification of Disease (ICD) 9 and 10 codes. Patients admitted with a history of LT were subdivided into those who were and were not diagnosed with an NA infection. Records were weighted using the NIS algorithm. Primary outcomes: all-cause hospital mortality, acute kidney injury (AKI), acute myocardial infarction (AMI), shock, and a composite of these. Secondary outcomes: length of stay, total charges, cytomegalovirus (CMV), and transplant rejection. Demographics and comorbidities were compared between groups with a weighted chi-square test. Outcomes were compared between the two groups, and adjusted odds ratios and regression coefficients were calculated using weighted logistic or linear regression as appropriate. Odds ratios (OR) were adjusted for age, gender, race, hospital characteristics, Charlson Comorbidity Index (CCI), median income based on zip code, weekend admission, and insurance.

Results: 469,141 LT patients were included in this study, 310 had NA infection (0.07%). Patients in each group were of similar age, race, and overall medical complexity (p >0.05). Patients with NA infection were less likely to have a history of CAD (4.84% vs 16.20%, p< 0.05), hypertension (14.53% vs 25.82%, p< 0.05), and obesity (1.61% vs 9.0%, p< 0.05) than controls. LT patients with NA infection were found to have higher odds of mortality (OR 5.50, p< 0.001), AKI (OR 1.9, p< 0.05), composite outcome (OR 2.19, p< 0.01), and more likely to have CMV infection (OR 6.38, p< 0.01). LT patients with NA infection stayed 13.11 days longer in the hospital (p< 0.01) with charges $60,399 more (p< 0.01) than controls. LT patients who acquired an NA infection were at nearly 6-fold higher odds of death and other negative outcomes.

Discussion: Based on previous research that has demonstrated organ transplant patients to be at high risk of infections. More vigilant care should be taken to protect LT patients from such opportunistic infections.


Disclosures:


James R. Pellegrini, MD¹, Andrej Sodoma, DO², Rezwan Munshi, MD³, Sonika Rathi, MS⁴, Samuel Greenberg, BA⁵, Tulika Saggar, MD⁶, Atul Sinha, MD⁶, Jiten Desai, MD⁶, Paul Mustacchia, MD, MBA⁶, Ana P. Rivera, MD⁷. P1136 - A 13-Year Nationwide Analysis of Nocardia and Actinomyces Infection Outcomes in Liver Transplant Recipients, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.