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Trung ND, Tam NC, Chinh DT, Nam H, Trung ND, Thao LTP, Marche PN, Su HX. Enterococcus avium Infection After Liver Transplantation in Vietnam: A Case Report. Transplant Proc 2025; 57:126-129. [PMID: 39694793 DOI: 10.1016/j.transproceed.2024.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 11/10/2024] [Indexed: 12/20/2024]
Abstract
BACKGROUND The infectious complications are the most common and can be life-threatening to liver transplant recipients, in particular, within the first month after transplantation. Early diagnosis of these severe complications and accurate detection of causative etiologies are crucial for the choice of therapeutic strategies and management of liver transplants. CASE REPORT We present a case report of a patient with a history of primary sclerosing cholangitis who underwent a liver transplantation (LT) from a living donor. The postoperative care was complicated with the hepatic artery thrombosis on day 16 and then the presence of sepsis on day 22 and intra-abdominal abscess on day 30, caused by Enterococcus avium (E. avium). The patient was treated with stent placement for hepatic artery thrombosis, percutaneous drainage of the abscess, and used an intensive intravenous antibiotic regimen with a combination of fosfomycin and vancomycin for a duration of 14 days. After the interventional procedure, the clinical examination and laboratory findings became normal and the patient left the hospital on day 46 in good general condition. CONCLUSION We diagnosed early and well-recognized complications during the perioperative care to make a prompt therapeutic approach with conservative treatment to rescue the patient without requiring urgent surgery and retransplantation.
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Affiliation(s)
- Ngo Dinh Trung
- Department of Surgical and Transplant Intensive Care Unit, Military Central Hospital 108, Vietnam.
| | - Nguyen Chi Tam
- Department of Surgical and Transplant Intensive Care Unit, Military Central Hospital 108, Vietnam
| | - Dao Trong Chinh
- Department of Surgical and Transplant Intensive Care Unit, Military Central Hospital 108, Vietnam
| | - Ho Nam
- Department of Surgical and Transplant Intensive Care Unit, Military Central Hospital 108, Vietnam
| | | | | | - Patrice N Marche
- Team Epigenetics, Immunity, Metabolism, Cell Signaling & Cancer, Institute for Advanced Biosciences, University Grenoble Alpes, Inserm U 1209, CNRS UMR 5309, Grenoble, France
| | - Hoang Xuan Su
- Institute of Biomedicine and Pharmacy, Vietnam Military Medical University, Hanoi, Vietnam.
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Kim DS, Yoon YI, Kim BK, Choudhury A, Kulkarni A, Park JY, Kim J, Sinn DH, Joo DJ, Choi Y, Lee JH, Choi HJ, Yoon KT, Yim SY, Park CS, Kim DG, Lee HW, Choi WM, Chon YE, Kang WH, Rhu J, Lee JG, Cho Y, Sung PS, Lee HA, Kim JH, Bae SH, Yang JM, Suh KS, Al Mahtab M, Tan SS, Abbas Z, Shresta A, Alam S, Arora A, Kumar A, Rathi P, Bhavani R, Panackel C, Lee KC, Li J, Yu ML, George J, Tanwandee T, Hsieh SY, Yong CC, Rela M, Lin HC, Omata M, Sarin SK. Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation. Hepatol Int 2024; 18:299-383. [PMID: 38416312 DOI: 10.1007/s12072-023-10629-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/18/2023] [Indexed: 02/29/2024]
Abstract
Liver transplantation is a highly complex and challenging field of clinical practice. Although it was originally developed in western countries, it has been further advanced in Asian countries through the use of living donor liver transplantation. This method of transplantation is the only available option in many countries in the Asia-Pacific region due to the lack of deceased organ donation. As a result of this clinical situation, there is a growing need for guidelines that are specific to the Asia-Pacific region. These guidelines provide comprehensive recommendations for evidence-based management throughout the entire process of liver transplantation, covering both deceased and living donor liver transplantation. In addition, the development of these guidelines has been a collaborative effort between medical professionals from various countries in the region. This has allowed for the inclusion of diverse perspectives and experiences, leading to a more comprehensive and effective set of guidelines.
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Affiliation(s)
- Dong-Sik Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young-In Yoon
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Jun Yong Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jongman Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Jin Joo
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Joong Choi
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki Tae Yoon
- Department of Internal Medicine, Pusan National University College of Medicine, Yangsan, Republic of Korea
| | - Sun Young Yim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Cheon-Soo Park
- Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Deok-Gie Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae Won Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Won-Mook Choi
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Eun Chon
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Woo-Hyoung Kang
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Geun Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yuri Cho
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Ilsan, Republic of Korea
| | - Pil Soo Sung
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Han Ah Lee
- Department of Internal Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Ji Hoon Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Si Hyun Bae
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Mo Yang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Mamun Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Soek Siam Tan
- Department of Medicine, Hospital Selayang, Batu Caves, Selangor, Malaysia
| | - Zaigham Abbas
- Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Ananta Shresta
- Department of Hepatology, Alka Hospital, Lalitpur, Nepal
| | - Shahinul Alam
- Crescent Gastroliver and General Hospital, Dhaka, Bangladesh
| | - Anil Arora
- Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital New Delhi, New Delhi, India
| | - Ashish Kumar
- Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital New Delhi, New Delhi, India
| | - Pravin Rathi
- TN Medical College and BYL Nair Hospital, Mumbai, India
| | - Ruveena Bhavani
- University of Malaya Medical Centre, Petaling Jaya, Selangor, Malaysia
| | | | - Kuei Chuan Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jun Li
- College of Medicine, Zhejiang University, Hangzhou, China
| | - Ming-Lung Yu
- Department of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | | | | | | | | | - H C Lin
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Masao Omata
- Department of Gastroenterology, Yamanashi Central Hospital, Yamanashi, Japan
- University of Tokyo, Bunkyo City, Japan
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Dolci G, Burastero GJ, Paglia F, Cervo A, Meschiari M, Guaraldi G, Chester J, Mussini C, Franceschini E. Epidemiology and Prevention of Early Infections by Multi-Drug-Resistant Organisms in Adults Undergoing Liver Transplant: A Narrative Review. Microorganisms 2023; 11:1606. [PMID: 37375108 DOI: 10.3390/microorganisms11061606] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/03/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Invasive bacterial infections are a leading cause of morbidity and mortality after liver transplant (LT), especially during the first months after LT, and infections due to multi-drug-resistant organisms (MDRO) are increasing in this setting. Most of the infections in patients in intensive care unit arise from the endogenous microflora and, for this reason, pre-LT MDRO rectal colonization is a risk factor for developing MDRO infections in the post-LT. Moreover, the transplanted liver may carry an increased risk of MDRO infections due to organ transportation and preservation, to donor intensive care unit stay and previous antibiotic exposure. To date, little evidence is available about how MDRO pre-LT colonization in donors and recipients should address LT preventive and antibiotic prophylactic strategies, in order to reduce MDRO infections in the post-LT period. The present review provided an extensive overview of the recent literature on these topics, with the aim to offer a comprehensive insight about the epidemiology of MDRO colonization and infections in adult LT recipients, donor-derived MDRO infections, possible surveillance, and prophylactic strategies to reduce post-LT MDRO infections.
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Affiliation(s)
- Giovanni Dolci
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
| | - Giulia Jole Burastero
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
| | - Francesca Paglia
- Infectious Diseases Unit, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Adriana Cervo
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
| | - Marianna Meschiari
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
| | - Giovanni Guaraldi
- Infectious Diseases Unit, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Johanna Chester
- Department of Dermatology, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Cristina Mussini
- Infectious Diseases Unit, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Erica Franceschini
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
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Neofytos D, Stampf S, Hoessly LD, D’Asaro M, Tang GN, Boggian K, Hirzel C, Khanna N, Manuel O, Mueller NJ, Van Delden C. Bacteremia During the First Year After Solid Organ Transplantation: An Epidemiological Update. Open Forum Infect Dis 2023; 10:ofad247. [PMID: 37323422 PMCID: PMC10267299 DOI: 10.1093/ofid/ofad247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/04/2023] [Indexed: 06/17/2023] Open
Abstract
Background There are limited contemporary data on the epidemiology and outcomes of bacteremia in solid organ transplant recipients (SOTr). Methods Using the Swiss Transplant Cohort Study registry from 2008 to 2019, we performed a retrospective nested multicenter cohort study to describe the epidemiology of bacteremia in SOTr during the first year post-transplant. Results Of 4383 patients, 415 (9.5%) with 557 cases of bacteremia due to 627 pathogens were identified. One-year incidence was 9.5%, 12.8%, 11.4%, 9.8%, 8.3%, and 5.9% for all, heart, liver, lung, kidney, and kidney-pancreas SOTr, respectively (P = .003). Incidence decreased during the study period (hazard ratio, 0.66; P < .001). One-year incidence due to gram-negative bacilli (GNB), gram-positive cocci (GPC), and gram-positive bacilli (GPB) was 5.62%, 2.81%, and 0.23%, respectively. Seven (of 28, 25%) Staphylococcus aureus isolates were methicillin-resistant, 2/67 (3%) enterococci were vancomycin-resistant, and 32/250 (12.8%) GNB produced extended-spectrum beta-lactamases. Risk factors for bacteremia within 1 year post-transplant included age, diabetes, cardiopulmonary diseases, surgical/medical post-transplant complications, rejection, and fungal infections. Predictors for bacteremia during the first 30 days post-transplant included surgical post-transplant complications, rejection, deceased donor, and liver and lung transplantation. Transplantation in 2014-2019, CMV donor-negative/recipient-negative serology, and cotrimoxazole Pneumocystis prophylaxis were protective against bacteremia. Thirty-day mortality in SOTr with bacteremia was 3% and did not differ by SOT type. Conclusions Almost 1/10 SOTr may develop bacteremia during the first year post-transplant associated with low mortality. Lower bacteremia rates have been observed since 2014 and in patients receiving cotrimoxazole prophylaxis. Variabilities in incidence, timing, and pathogen of bacteremia across different SOT types may be used to tailor prophylactic and clinical approaches.
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Affiliation(s)
- Dionysios Neofytos
- Correspondence: Dionysios Neofytos, MD, MPH, Service des Maladies Infectieuses, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, CH-1211 Genève 14, Switzerland (); or Christian van Delden, MD, Service des Maladies Infectieuses, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, CH-1211 Genève 14, Switzerland ()
| | - Susanne Stampf
- Clinic for Transplantation Immunology and Nephrology (Swiss Transplant Cohort Study), University Hospital of Basel, Basel, Switzerland
| | - Linard D Hoessly
- Clinic for Transplantation Immunology and Nephrology (Swiss Transplant Cohort Study), University Hospital of Basel, Basel, Switzerland
| | - Matilde D’Asaro
- Transplant Infectious Diseases Unit, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Gael Nguyen Tang
- Transplant Infectious Diseases Unit, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Katia Boggian
- Division of Infectious Diseases, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Cedric Hirzel
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nina Khanna
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | - Oriol Manuel
- Division of Infectious Diseases, University Hospital of Vaud, Lausanne, Switzerland
| | - Nicolas J Mueller
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, Switzerland
| | - Christian Van Delden
- Correspondence: Dionysios Neofytos, MD, MPH, Service des Maladies Infectieuses, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, CH-1211 Genève 14, Switzerland (); or Christian van Delden, MD, Service des Maladies Infectieuses, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, CH-1211 Genève 14, Switzerland ()
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Prevalence, mortality, and resource utilization of Staphylococcus aureus bacteremia in liver transplant recipients: A 2012–2016 nationwide analysis. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Chen F, Pang XY, Shen C, Han LZ, Deng YX, Chen XS, Zhang JJ, Xia Q, Qian YB. High mortality associated with gram-negative bacterial bloodstream infection in liver transplant recipients undergoing immunosuppression reduction. World J Gastroenterol 2020; 26:7191-7203. [PMID: 33362376 PMCID: PMC7723669 DOI: 10.3748/wjg.v26.i45.7191] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/30/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Immunosuppression is an important factor in the incidence of infections in transplant recipient. Few studies are available on the management of immunosuppression (IS) treatment in the liver transplant (LT) recipients complicated with infection. The aim of this study is to describe our experience in the management of IS treatment during bacterial bloodstream infection (BSI) in LT recipients and assess the effect of temporary IS withdrawal on 30 d mortality of recipients presenting with severe infection.
AIM To assess the effect of temporary IS withdrawal on 30 d mortality of LT recipients presenting with severe infection.
METHODS A retrospective study was conducted with patients diagnosed with BSI after LT in the Department of Liver Surgery, Renji Hospital from January 1, 2016 through December 31, 2017. All recipients diagnosed with BSI after LT were included. Univariate and multivariate Cox regression analysis of risk factors for 30 d mortality was conducted in the LT recipients with Gram-negative bacterial (GNB) infection.
RESULTS Seventy-four episodes of BSI were identified in 70 LT recipients, including 45 episodes of Gram-positive bacterial (GPB) infections in 42 patients and 29 episodes of GNB infections in 28 patients. Overall, IS reduction (at least 50% dose reduction or cessation of one or more immunosuppressive agent) was made in 28 (41.2%) cases, specifically, in 5 (11.9%) cases with GPB infections and 23 (82.1%) cases with GNB infections. The 180 d all-cause mortality rate was 18.5% (13/70). The mortality rate in GNB group (39.3%, 11/28) was significantly higher than that in GPB group (4.8%, 2/42) (P = 0.001). All the deaths in GNB group were attributed to worsening infection secondary to IS withdrawal, but the deaths in GPB group were all due to graft-versus-host disease. GNB group was associated with significantly higher incidence of intra-abdominal infection, IS reduction, and complete IS withdrawal than GPB group (P < 0.05). Cox regression showed that rejection (adjusted hazard ratio 7.021, P = 0.001) and complete IS withdrawal (adjusted hazard ratio 12.65, P = 0.019) were independent risk factors for 30 d mortality in patients with GNB infections after LT.
CONCLUSION IS reduction is more frequently associated with GNB infection than GPB infection in LT recipients. Complete IS withdrawal should be cautious due to increased risk of mortality in LT recipients complicated with BSI.
IS
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Affiliation(s)
- Fang Chen
- Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Xiao-Yun Pang
- Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Chuan Shen
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Long-Zhi Han
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Yu-Xiao Deng
- Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Xiao-Song Chen
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Jian-Jun Zhang
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Qiang Xia
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Yong-Bing Qian
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
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Huang XQ, Qiu JK, Wang CH, Pan L, Xu JK, Pan XH, Ji XB, Mao MJ. Sepsis secondary to multifocal Enterococcus faecium infection: A case report. Medicine (Baltimore) 2020; 99:e19811. [PMID: 32629622 PMCID: PMC7337606 DOI: 10.1097/md.0000000000019811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Nosocomial Enterococcus faecium (E faecium) infections are common among immunocompromised patients; however, sepsis caused by E faecium is rarely encountered in the clinical setting. PATIENT CONCERNS A 69-year-old woman with a previous history of tuberculosis (TB), developed symptoms of recurrent fever, paroxysmal cough, and exertional dyspnea for over 2 months before she presented to the hospital. DIAGNOSIS The patient was initially misdiagnosed with recurrent TB, and did not respond to anti-TB therapy. Culture results of blood, endotracheal necrotic tissue, and urine confirmed a diagnosis of multifocal E faecium infection. INTERVENTIONS On definitive diagnosis, the patient received intensive antimicrobial combination treatment with linezolid, teicoplanin, caspofungin, and voriconazole on the basis of antimicrobial susceptibility results. OUTCOMES After transient improvement, the patient's condition deteriorated due to secondary infections, and the patient died after discharge against medical advice. CONCLUSION E faecium bacteremia may cause sepsis in immunocompromised patients, and has a high mortality rate. Careful pathogen detection and early initiation of treatment is crucial to good patient outcome.
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Using VRE screening tests to predict vancomycin resistance in enterococcal bacteremia. Infect Control Hosp Epidemiol 2020; 41:425-429. [PMID: 31973783 DOI: 10.1017/ice.2019.380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Enterococcus causes clinically significant bloodstream infections (BSIs). In centers with a higher prevalence of vancomycin resistant enterococcus (VRE) colonization, a common clinical question is whether empiric treatment directed against VRE should be initiated in the setting of a suspected enterococcal BSI. Unfortunately, VRE treatment options are limited, and relatively expensive, and subject patients to the risk of adverse reactions. We hypothesized that the results of VRE colonization screening could predict vancomycin resistance in enterococcal BSI. METHODS We reviewed 370 consecutive cases of enterococcal BSI over a 7-year period at 2 tertiary-care hospitals to determine whether vancomycin-resistant BSIs could be predicted based on known colonization status (ie, patients with swabs performed within 30 days, more remotely, or never tested). We calculated sensitivity and specificity, and we plotted negative predictives values (NPVs) and positive predictive values (PPVs) as a function of prevalence. RESULTS A negative screening swab within 30 days of infection yielded NPVs of 90% and 95% in settings where <27.0% and 15.0% of enterococcal BSI are resistant to vancomycin, respectively. In patients with known VRE colonization, the PPV for VRE in enterococcal BSI was >50% at any prevalence exceeding 25%. CONCLUSIONS The results of a negative VRE screening test result performed within 30 days can help eliminate unnecessary empiric therapy in patients with suspected enterococcal BSI. Conversely, patients with positive VRE screening swabs require careful consideration of empiric VRE-directed therapy when enterococcal BSI appears likely.
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9
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Cakin O, Cakici S, Karaveli A, Yildiz İ, Ogunc D, Gunsever F, Aydinli B, Cengiz M, Yilmaz M, Ramazanoglu A. Liver Transplantation and Early Culture Growth: Risk and Impact? Transplant Proc 2019; 51:2466-2468. [PMID: 31405745 DOI: 10.1016/j.transproceed.2019.01.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 01/28/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Despite advances in immunosuppressive drugs, postoperative care, and surgical techniques, bacterial infections remain the most important cause of morbidity and mortality in liver transplant patients. The aim of this study is to evaluate the influence of culture results taken on the first day of admission to intensive care unit on mortality, graft rejection, mechanical ventilation duration, and length of intensive care unit stay. Our study has clinical importance because it is the first study evaluating the cultures obtained on the first day of intensive care unit stays in liver transplant patients. METHODS Patients' demographic data, transplant type, rates of deceased and living donors, culture results, amount of blood and blood products used intraoperatively, previous hospital admission, mortality, incidence of graft rejection, mechanical ventilation duration, and length of intensive care unit stay were recorded. RESULTS Mortality and graft rejection were 14.8% and 9%, respectively. The mortality was significantly higher in all 3 cultures and/or in only blood culture-positive patients. Graft rejection, mechanical ventilation duration, and length of intensive care unit stay were significantly higher in patients whose 3 cultures were all positive. Only body mass index had a significant effect on mortality, graft rejection, and positive culture results. CONCLUSIONS Liver transplant patients' first postoperative day culture results were correlated with mortality, graft rejection, mechanical ventilation duration, and length of intensive care unit stay.
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Affiliation(s)
- Ozlem Cakin
- University of Health Sciences, Antalya Education and Research Hospital, Department of ICU, Antalya, Turkey.
| | - Selen Cakici
- Akdeniz University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Antalya, Turkey
| | - Arzu Karaveli
- University of Health Sciences, Antalya Education and Research Hospital, Department of Anesthesiology and Reanimation, Antalya, Turkey
| | - İsmail Yildiz
- Akdeniz University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Antalya, Turkey
| | - Dilara Ogunc
- Akdeniz University, Faculty of Medicine, Department of Microbiology, Antalya, Turkey
| | - Filiz Gunsever
- Akdeniz University, Faculty of Medicine, Department of Infection Diseases, Antalya, Turkey
| | - Bulent Aydinli
- Akdeniz University, Faculty of Medicine, Department of General Surgery, Antalya, Turkey
| | - Melike Cengiz
- Akdeniz University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Antalya, Turkey
| | - Murat Yilmaz
- Akdeniz University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Antalya, Turkey
| | - Atilla Ramazanoglu
- Akdeniz University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Antalya, Turkey
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He Q, Liu P, Li X, Su K, Peng D, Zhang Z, Xu W, Qin Z, Chen S, Li Y, Qiu J. Risk factors of bloodstream infections in recipients after liver transplantation: a meta-analysis. Infection 2018; 47:77-85. [PMID: 30370489 DOI: 10.1007/s15010-018-1230-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 09/28/2018] [Indexed: 12/13/2022]
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Liu T, Zhang Y, Wan Q. Methicillin-resistant Staphylococcus aureus bacteremia among liver transplant recipients: epidemiology and associated risk factors for morbidity and mortality. Infect Drug Resist 2018; 11:647-658. [PMID: 29765236 PMCID: PMC5939879 DOI: 10.2147/idr.s161180] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Bacteremia due to Staphylococcus aureus, especially methicillin-resistant S. aureus (MRSA), complicates the clinical course of liver transplantation and is associated with high morbidity and mortality. Intravascular catheters had been reported to be the most frequent source of MRSA bacteremia. Among bacteremic liver recipients, 26.3%-100% of S. aureus were MRSA. Previous studies identified pre-transplant and post-transplant acquired S. aureus carriage, greater severity of liver disease, hepatocellular carcinoma and infection with immuno-modulatory viruses as predictors of S. aureus bacteremia in liver recipients. MRSA bacteremia accompanied by pneumonia and abdominal infections was related to mortality. Vancomycin, as well as daptomycin, is a first-line antibiotic for MRSA bacteremia. The purpose of this review is to better understand the characteristics of MRSA bacteremia by summarizing the epidemiology and antimicrobial resistance of S. aureus, the primary source, and related risk factors for morbidity and mortality of MRSA bacteremia. We have also explored the diagnostic, therapeutic and preventive measures for MRSA bacteremia to improve the outcomes of liver recipients.
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Affiliation(s)
- Taohua Liu
- Department of Clinical Medicine, Xiangya School of Medicine, Central South University, Changsha, People’s Republic of China
| | - Yuezhong Zhang
- Department of Clinical Medicine, Xiangya School of Medicine, Central South University, Changsha, People’s Republic of China
| | - Qiquan Wan
- Department of Transplant Surgery, the Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
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12
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Epidemiology of Bloodstream Infections in a Multicenter Retrospective Cohort of Liver Transplant Recipients. Transplant Direct 2016; 2:e67. [PMID: 27458606 PMCID: PMC4946508 DOI: 10.1097/txd.0000000000000573] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 11/10/2015] [Indexed: 12/25/2022] Open
Abstract
UNLABELLED Although some studies have examined the epidemiology of bloodstream infections after liver transplantation, they were based in single centers and did not identify bloodstream infections treated in other hospitals. METHODS We retrospectively examined a cohort of 7912 adult liver transplant recipients from 24 transplant centers using 2004 to 2012 International Classification of Diseases, Ninth Revision, Clinical Modification billing data from 3 State Inpatient Databases, and identified bloodstream infections, inpatient death, and cumulative 1-year hospital costs. Multilevel Cox regression analyses were used to determine factors associated with bloodstream infections and death. RESULTS Bloodstream infections were identified in 29% (n = 2326) of liver transplant recipients, with a range of 19% to 40% across transplant centers. Only 63% of bloodstream infections occurring more than 100 days posttransplant were identified at the original transplant center. Bloodstream infections were associated with posttransplant laparotomy (adjusted hazard ratio [aHR], 1.52), prior liver transplant (aHR, 1.42), increasing age (aHR, 1.07/decade), and some comorbidities. Death was associated with bloodstream infections with and without septic shock (aHR, 10.96 and 3.71, respectively), transplant failure or rejection (aHR, 1.41), posttransplant laparotomy (aHR, 1.40), prior solid-organ transplant (aHR, 1.48), increasing age (aHR, 1.15/decade), and hepatitis C cirrhosis (aHR, 1.20). The risk of bloodstream infections and death varied across transplant centers. Median 1-year cumulative hospital costs were higher for patients who developed bloodstream infections within 1 year of transplant compared with patients who were bloodstream infection-free (US $229 806 vs US $111 313; P < 0.001). CONCLUSIONS Bloodstream infections are common and costly complications after liver transplantation that are associated with a markedly increased risk of death. The incidence and risk of developing bloodstream infections may vary across transplant centers.
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Shao M, Wan Q, Xie W, Ye Q. Bloodstream infections among solid organ transplant recipients: epidemiology, microbiology, associated risk factors for morbility and mortality. Transplant Rev (Orlando) 2014; 28:176-181. [PMID: 24630890 DOI: 10.1016/j.trre.2014.02.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 09/26/2013] [Accepted: 02/09/2014] [Indexed: 12/15/2022]
Abstract
Bloodstream infections (BSIs) remain important causes of morbidity and mortality among solid organ transplant (SOT) recipients and still threaten the success of SOT. In general, among SOT recipients, risk factors for BSIs are associated with prior ICU admission, catheterization, older recipient or donor age…etc. Pulmonary focus, nosocomial source of BSIs, lack of appropriate antibiotic therapy and other variables have significant impacts on BSIs-related mortality in SOT. Most of BSIs in SOT are caused by gram-negative bacteria. However, all aspects including microbiological spectrum, morbidity and mortality rates, risk factors of BSIs and BSIs-related death depend on the type of transplantation. The purpose of this review is to summarize the epidemiology, microbiologic features including antimicrobial resistance of organisms, and associated risk factors for morbidity and mortality of BSIs according to different type of transplantation to better understand the characteristics of BSIs and improve the outcomes after SOT.
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Affiliation(s)
- Mingjie Shao
- Department of Transplant Surgery, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, China
| | - Qiquan Wan
- Department of Transplant Surgery, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, China.
| | - Wenzhao Xie
- Department of Transplant Surgery, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, China
| | - Qifa Ye
- Department of Transplant Surgery, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, China
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14
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Nie K, Ran R, Tan W, Yi B, Luo X, Yu Y, Jiang X. Risk factors of intra-abdominal bacterial infection after liver transplantation in patients with hepatocellular carcinoma. Chin J Cancer Res 2014; 26:309-14. [PMID: 25035658 DOI: 10.3978/j.issn.1000-9604.2014.06.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 06/05/2014] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To explore the risk factors of intra-abdominal bacterial infection (IAI) after liver transplantation (LT) in patients with hepatocellular carcinoma (HCC). METHODS A series of 82 HCC patients who received LT surgeries in our department between March 2004 and April 2010 was recruited in this study. Then we collected and analyzed the clinical data retrospectively. Statistical analysis system (SPSS) software was adopted to perform statistical analysis. Chi-square test, t-test and Wilcoxon rank sum test were used to analyze the clinical data and compute the significance of the incidences of early-stage IAI after LT for HCC patients. Binary logistic regression was performed to screen out the risk factors, and multiple logistic regression analyses were performed to compute the independent risk factors. RESULTS A series of 13 patients (13/82, 15.9%) had postoperative IAI. The independent risk factors of postoperative intra-abdominal bacterial infections after LT for HCC patients were preoperative anemia [Hemoglobin (HGB) <90 g/L] and postoperative abdominal hemorrhage (72 hours >400 mL), with the odds ratios at 8.121 (95% CI, 1.417 to 46.550, P=0.019) and 5.911 (95% CI, 1.112 to 31.432, P=0.037). CONCLUSIONS Postoperative IAI after LT in patients with HCC was a common complication. Preoperative moderate to severe anemia, as well as postoperative intra-abdominal hemorrhage more than 400 mL within the first 72 hours might independently indicate high risk of IAI for these patients.
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Affiliation(s)
- Kai Nie
- 1 The 175th hospital of PLA, Zhangzhou 363000, China ; 2 Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Chang-Hai road 225, Shanghai 200438, China
| | - Rongzheng Ran
- 1 The 175th hospital of PLA, Zhangzhou 363000, China ; 2 Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Chang-Hai road 225, Shanghai 200438, China
| | - Weifeng Tan
- 1 The 175th hospital of PLA, Zhangzhou 363000, China ; 2 Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Chang-Hai road 225, Shanghai 200438, China
| | - Bin Yi
- 1 The 175th hospital of PLA, Zhangzhou 363000, China ; 2 Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Chang-Hai road 225, Shanghai 200438, China
| | - Xiangji Luo
- 1 The 175th hospital of PLA, Zhangzhou 363000, China ; 2 Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Chang-Hai road 225, Shanghai 200438, China
| | - Yong Yu
- 1 The 175th hospital of PLA, Zhangzhou 363000, China ; 2 Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Chang-Hai road 225, Shanghai 200438, China
| | - Xiaoqing Jiang
- 1 The 175th hospital of PLA, Zhangzhou 363000, China ; 2 Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Chang-Hai road 225, Shanghai 200438, China
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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013; 14:73-156. [PMID: 23461695 DOI: 10.1089/sur.2013.9999] [Citation(s) in RCA: 756] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Dale W Bratzler
- College of Public Health, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma 73126-0901, USA.
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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70:195-283. [DOI: 10.2146/ajhp120568] [Citation(s) in RCA: 1364] [Impact Index Per Article: 113.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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17
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Identification of Nor-β-Lapachone Derivatives as Potential Antibacterial Compounds against Enterococcus faecalis Clinical Strain. Curr Microbiol 2010; 62:684-9. [DOI: 10.1007/s00284-010-9763-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 09/03/2010] [Indexed: 01/26/2023]
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18
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Bert F, Larroque B, Paugam-Burtz C, Janny S, Durand F, Dondero F, Valla DC, Belghiti J, Moreau R, Nicolas-Chanoine MH. Microbial epidemiology and outcome of bloodstream infections in liver transplant recipients: an analysis of 259 episodes. Liver Transpl 2010; 16:393-401. [PMID: 20209598 DOI: 10.1002/lt.21991] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Bloodstream infections (BSIs) are a major cause of mortality in liver transplant recipients. The incidence, microbiology, and outcome of BSIs in the first year after liver transplantation were analyzed in 704 patients who underwent transplantation at a single center between 1997 and 2007. BSIs occurred in 205 (29.1%) of the 704 patients. Overall, 259 episodes were documented, and they resulted in an incidence rate of 36.8%. Of these episodes, 39.4%, 27.8%, 17%, and 15.8% occurred in the very early period (< or = 10 days after liver transplantation), the early period (days 11-30), the intermediate period (days 31-90), and the late period (days 91-365), respectively. The most frequent pathogens were Enterobacteriaceae members (41%), Staphylococcus aureus (19.8%), enterococci (13.1%), Pseudomonas aeruginosa (8.8%), and yeasts (7.1%). The median time of onset ranged from 7 days for methicillin-resistant S. aureus to 25 days for Enterobacteriaceae. Mortality at 15 days after BSIs was 16.2%. Kaplan-Meier survival curves showed that patients with BSIs had a significantly higher 1-year mortality rate than those without BSIs (28.3% versus 16.6%, P < 0.001 with the log-rank test). When the time of BSI onset was considered, 1-year mortality was significantly associated with very early and early episodes (P < 0.001) but not with intermediate and late episodes (P = 0.47). In conclusion, BSIs are frequent and early complications after liver transplantation and are mostly caused by gram-negative bacilli. A BSI in the first posttransplant month is a significant predictor of 1-year survival.
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Affiliation(s)
- Frédéric Bert
- Department of Microbiology, APHP, Beaujon Hospital, Clichy, France.
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Hsu J, Andes DR, Knasinski V, Pirsch J, Safdar N. Statins are associated with improved outcomes of bloodstream infection in solid-organ transplant recipients. Eur J Clin Microbiol Infect Dis 2009; 28:1343-51. [PMID: 19669657 DOI: 10.1007/s10096-009-0787-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 07/10/2009] [Indexed: 10/20/2022]
Abstract
Among recipients of intra-abdominal solid-organ transplants, bloodstream infections (BSIs) are a major cause of mortality. We undertook a retrospective cohort study of recipients of kidney, pancreas, and/or liver transplants with BSIs at a single center over an 11-year period. Multivariate analysis using logistic regression was used to determine independent predictors of 15-day mortality and clinical cure, with a focus on the use of statins. Three hundred and eleven recipients of solid-organ transplants had 604 episodes of BSI. Forty-four (14%) died within 15 days of BSI. Sixteen percent did not achieve clinical cure. In the multivariate model, each one point increase in the APACHE score was associated with a 1.09-fold increased risk of death (95% confidence interval [CI] 1.00-1.18, P = 0.03). The lack of appropriate antibiotic therapy was associated with a four-fold higher risk of death within 15 days (odds ratio [OR] 4.65, 95% CI 1.46-14.78, P = 0.009). Statin use was protective (OR 0.18, 95% CI 0.04-0.78). Patients with high APACHE scores, nosocomial rather than community source of BSI, lack of appropriate antibiotic therapy, and mental status changes were less likely to achieve clinical cure of their BSIs. In conclusion, appropriate antibiotic therapy and statin use are associated with lower risk of mortality from BSIs in this patient population.
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Affiliation(s)
- J Hsu
- Section of Infectious Diseases, Department of Medicine, University of Wisconsin, Room H4/572 CSC, 600 Highland Avenue, Madison, WI 53792, USA
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Kim SI, Kim YJ, Jun YH, Wie SH, Kim YR, Choi JY, Yoon SK, Moon IS, Kim DG, Lee MD, Kang MW. Epidemiology and risk factors for bacteremia in 144 consecutive living-donor liver transplant recipients. Yonsei Med J 2009; 50:112-21. [PMID: 19259357 PMCID: PMC2649862 DOI: 10.3349/ymj.2009.50.1.112] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Accepted: 10/22/2008] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Bacteremia is a major infectious complication associated with mortality in liver transplant recipients. The causative organisms and clinical courses differ between medical centers due to variations in regional bacterial epidemiology and posttransplant care. Further, living donors in Korea contribute to 83% of liver transplants, and individualized data are required to improve survival rates. PATIENTS AND METHODS We retrospectively analyzed 104 subjects who had undergone living-donor liver transplant from 2005 to 2007. RESULTS Among the 144 consecutive living-donor liver transplant recipients, 24% (34/144) developed bacteremia, 32% (46/144) developed non-bacteremic infections, and 44% (64/144) did not develop any infectious complications. Forty episodes of bacteremia occurred in 34 recipients. The major sources of bacteremia were intravascular catheter (30%; 12/40), biliary tract (30%; 12/40), and abdomen (22.5%; 9/40). Gram-positive cocci were more common (57.5%; 23/40) than Gram-negative rods (32.5 %; 13/40) and fungi (10%; 4/40). The data revealed that the following factors were significantly different between the bacteremia, non-bacteremic infection, and no infection groups: age (p = 0.024), posttransplant hemodialysis (p = 0.002), ICU stay (p = 0.012), posttransplant hospitalization (p < 0.0001), and duration of catheterization (p < 0.0001). The risk factors for bacteremia were older than 55 years (odds ratio, 6.1; p = 0.003), catheterization for more than 22 days (odds ratio, 4.0; p = 0.009), UNOS class IIA (odds ratio, 6.6; p = 0.039), and posttransplant hemodialysis (odds ratio, 23.1; p = 0.001). One-year survival rates in the bacteremic, non-bacteremic infection, and no infection groups were 73.2%, 91.3%, and 93.5%, respectively. CONCLUSION Early catheter removal and preservation of renal function should focus for improving survival after transplant.
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Affiliation(s)
- Sang Il Kim
- Department of Internal Medicine, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youn Jeong Kim
- Department of Internal Medicine, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Hee Jun
- Department of Internal Medicine, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seong Heon Wie
- Department of Internal Medicine, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yang Ree Kim
- Department of Internal Medicine, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Young Choi
- Department of Internal Medicine, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Kyu Yoon
- Department of Internal Medicine, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Sung Moon
- Department of Surgery, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Goo Kim
- Department of Surgery, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myung Duk Lee
- Department of Surgery, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moon Won Kang
- Department of Internal Medicine, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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22
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22 Levertransplantatie. LEVERZIEKTEN 2009. [PMCID: PMC7121307 DOI: 10.1007/978-90-313-7437-3_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In 1963 verrichtte Thomas Starzl in Denver de eerste levertransplantatie bij de mens. In 1966 werden in Nederland de eerste twee (auxiliaire, zie par. 22.3.6) levertransplantaties verricht in Leiden en Arnhem, in 1968 startte Cambridge. Helaas resulteerden de eerste levertransplantaties niet in langetermijnoverleving als gevolg van niet-optimale operatietechniek, matige immuunsuppressie en onbekendheid met complicaties.
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Kim BS, Lee SG, Hwang S, Ahn CS, Kim KH, Moon DB, Ha TY, Song GW, Jung DH. Influence of pretransplantation bacterial and fungal culture positivity on outcome after living donor liver transplantation. Transplant Proc 2009; 41:250-252. [PMID: 19249527 DOI: 10.1016/j.transproceed.2008.10.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Revised: 09/09/2008] [Accepted: 10/29/2008] [Indexed: 01/29/2023]
Abstract
BACKGROUND Bacterial and fungal infections are serious complications in patients with cirrhosis and are among the main causes of morbidity and mortality. The effects of pretransplantation infection on the outcome after orthotopic liver transplantation (OLT), however, have not been fully described. OBJECTIVE To assess the influence of pretransplantation infection on OLT by analyzing the clinical profiles of liver recipients with preexisting bacterial or fungal infection. PATIENTS AND METHODS We retrospectively reviewed the medical records of 223 adult patients who underwent living donor OLT between October 1, 2005, and September 30, 2006. In all patients, routine blood culture, was performed, and in patients with suspected bacterial or fungal infection; sputum, urine, and ascitic fluid cultures were performed. RESULTS Of 223 patients, 37 (16.6%) had a positive culture in one or more samples. Culture-positive and culture-negative groups differed significantly in end-stage liver disease score but showed no differences in Child-Turcotte-Pugh score, existence of spontaneous bacterial peritonitis, hemodialysis, or duration of stay in the intensive care unit or hospital. Six of 37 patients with positive cultures (16.2%) and 4 (2.2%) of 186 patients with negative cultures (2.2%) died during the first 90 days after OLT (P = .007). The causes of death among culture-positive patients were brain edema (n = 2), brain hemorrhage (n = 1), hepatic dysfunction (n = 1), and sepsis (n = 2), whereas all 4 culture-negative patients died of infectious complications. CONCLUSION Prompt OLT accompanied by adequate antibiotic or antifungal therapy may be acceptable in patients with preexisting bacterial or fungal infection unless there are overt manifestations of active infection.
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Affiliation(s)
- B-S Kim
- Department of Surgery, East-West Neo Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
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