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Mularoni A, Cona A, Campanella M, Barbera F, Medaglia AA, Cervo A, Cuscino N, Di Mento G, Graziano E, El Jalbout JD, Alduino R, Tuzzolino F, Monaco F, Cascio A, Peghin M, Gruttadauria S, Bertani A, Conaldi PG, Mikulska M, Grossi PA. Donor-derived carbapenem-resistant gram-negative bacterial infections in solid organ transplant recipients: Active surveillance enhances recipient safety. Am J Transplant 2024; 24:1046-1056. [PMID: 38342183 DOI: 10.1016/j.ajt.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/16/2024] [Accepted: 02/04/2024] [Indexed: 02/13/2024]
Abstract
Donor-derived infections (DDIs) caused by carbapenem-resistant gram-negative bacteria (CR-GNB) in solid organ transplant recipients are potentially life-threatening. In this prospective study, we evaluated the incidence, factors associated with transmission, and the outcome of recipients with unexpected CR-GNB DDIs after the implementation of our local active surveillance system (LASS). LASS provides for early detection of unexpected donor CR-GNB infections, prophylaxis of recipients at high risk, and early diagnosis and treatment of DDIs. Whole genome sequencing confirmed DDI. Among 791 recipients, 38 (4.8%) were at high risk of unexpected CR-GNB DDI: 25 for carbapenem-resistant Enterobacterales (CRE) and 13 for carbapenem-resistant Acinetobacter baumannii (CRAB). Transmission did not occur in 27 (71%) cases, whereas DDIs occurred in 9 of 25 of CRE and 2 of 13 of CRAB cases. Incidence of CR-GNB DDI was 1.4%. Recipients of organs with CR-GNB-positive preservation fluid and liver recipients from a donor with CRE infection were at the highest risk of DDI. There was no difference in length of hospital stay or survival in patients with and without CR-GNB DDI. Our LASS contains transmission and mitigates the negative impacts of CR-GNB DDI. Under well-defined conditions, organs from donors with CR-GNB may be considered after a thorough evaluation of the risk/benefit profile.
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Affiliation(s)
- Alessandra Mularoni
- Unit of Infectious Diseases and Infection Control, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Andrea Cona
- Unit of Infectious Diseases and Infection Control, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy.
| | - Maria Campanella
- Unit of Infectious Diseases and Infection Control, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Floriana Barbera
- Pathology Unit, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Alice Annalisa Medaglia
- Unit of Infectious Diseases and Infection Control, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy; Infectious and Tropical Disease Unit, AOU Policlinico 'P. Giaccone', Palermo, Italy
| | - Adriana Cervo
- Unit of Infectious Diseases and Infection Control, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy; University Hospital of Modena, Infectious Diseases Clinic, Modena, Italy
| | - Nicola Cuscino
- Department of Research, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Giuseppina Di Mento
- Pathology Unit, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Elena Graziano
- Unit of Infectious Diseases and Infection Control, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy; Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, Varese, Italy
| | - Jana Dib El Jalbout
- Unit of Infectious Diseases and Infection Control, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy; Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Rossella Alduino
- Department of Research, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Fabio Tuzzolino
- Department of Research, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Francesco Monaco
- Pathology Unit, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Antonio Cascio
- Infectious and Tropical Disease Unit, AOU Policlinico 'P. Giaccone', Palermo, Italy
| | - Maddalena Peghin
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, Varese, Italy
| | - Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Disease and Abdominal Transplantation, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Alessandro Bertani
- Division of Thoracic Surgery and Lung Transplantation, Chest Center, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Pier Giulio Conaldi
- Department of Research, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paolo Antonio Grossi
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, Varese, Italy
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García-Carrera CJ, Rivera-Lopez FE, Papacristofilou-Riebeling B, Fernández-García OA, García-Juárez I. Liver transplantation from a donor with multidrug-resistant Acinetobacter baumannii infection. Is it a risk? REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2023; 88:436-439. [PMID: 37679241 DOI: 10.1016/j.rgmxen.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/08/2023] [Indexed: 09/09/2023]
Affiliation(s)
- C J García-Carrera
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - F E Rivera-Lopez
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - B Papacristofilou-Riebeling
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - O A Fernández-García
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City,Mexico
| | - I García-Juárez
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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Eze EC, Falgenhauer L, El Zowalaty ME. Draft genome sequences of extensively drug resistant and pandrug resistant Acinetobacter baumannii strains isolated from hospital wastewater in South Africa. J Glob Antimicrob Resist 2022; 31:286-291. [PMID: 36058511 DOI: 10.1016/j.jgar.2022.08.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/06/2022] [Accepted: 08/29/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Acinetobacter baumannii is a significant opportunistic pathogen causing nosocomial infections. Infections caused by A. baumannii are often difficult to treat because this bacterium is often multidrug-resistant and shows high environmental adaptability. Here, we report on the analysis of three A. baumannii strains isolated from hospital effluents in South Africa. METHODS Strains were isolated on Leeds Acinetobacter agar and were identified using VITEK®2 platform. Antibiotic susceptibility testing was performed using the Kirby-Bauer Disk diffusion method. Whole-genome sequencing was performed. The assembled contigs were annotated. Multilocus sequence type, antimicrobial resistance, and virulence genes were identified. RESULTS The strains showed two multilocus sequence types, ST231 (FA34) and ST1552 (PL448, FG116). Based on their antibiotic susceptibility profiles, PL448 and FG116 were classified as extensively drug-resistant and FA34 as pandrug-resistant. FA34 harbored mutations in LpxA, LpxC, and PmrB, conferring resistance to colistin, but not mcr genes. All three strains encoded virulence genes for immune evasion (capsule, lipopolysaccharide [LPS]), iron uptake, and biofilm formation. FA34 was related to human strains from South Africa; PL448 and FG116 were related to a strain isolated in the United States from a human wound. CONCLUSIONS The detection of extensively drug- and pandrug-resistant A. baumannii strains in hospital effluents is of particular concern. It indicates that wastewater might play a role in the spread of these bacteria. Our data provide insight into the molecular epidemiology, resistance, pathogenicity, and distribution of A. baumannii in South Africa.
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Affiliation(s)
- Emmanuel C Eze
- Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Linda Falgenhauer
- Institute of Hygiene and Environmental Medicine, German Center for Infection Research, Site Giessen-Marburg-Langen and Hessian University Competence Center for Hospital Hygiene, Justus Liebig University Giessen, Germany
| | - Mohamed E El Zowalaty
- Veterinary Medicine and Food Security Research Group, Medical Laboratory Sciences Program, Division of Health Sciences, Abu Dhabi Women's Campus, Higher Colleges of Technology, Abu Dhabi, UAE; Zoonosis Science Center, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden.
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Borges Duarte DF, Gonçalves Rodrigues A. Acinetobacter baumannii: insights towards a comprehensive approach for the prevention of outbreaks in health-care facilities. APMIS 2022; 130:330-337. [PMID: 35403751 DOI: 10.1111/apm.13227] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/07/2022] [Indexed: 12/14/2022]
Abstract
Acinetobacter baumannii is known to be an opportunistic pathogen frequently responsible for outbreaks in health-care facilities, particularly in Intensive Care Units (ICU). It can easily survive in the hospital setting for long periods and can be transmitted throughout the hospital in a variety of ways, explored in this review. It can also easily acquire antibiotic resistance determinants rendering several antibiotic drugs useless. In 2019, the US Centre for Disease Control (CDC) considered the organism as an urgent threat. The aim of this review was to raise the awareness of the medical community about the relevance of this pathogen and discuss how it may impact seriously the healthcare institutions particularly in the aftermath of the recent COVID-19 pandemic. PubMed was searched, and articles that met inclusion criteria were reviewed. We conclude by the need to raise awareness to this pathogen's relevance and to encourage the implementation of preventive measures in order to mitigate its consequences namely the triage of specific high-risk patients.
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Affiliation(s)
- Diogo Filipe Borges Duarte
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Acácio Gonçalves Rodrigues
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal.,RISE - Health Research Network, Porto, Portugal.,Burn Unit, Department of Plastic and Reconstructive Surgery, S. Joao University Center Hospital, Porto, Portugal
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5
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Zhang F, Zhong J, Ding H, Liao G. Effects of preservative fluid associated possible donor-derived carbapenem-resistant Klebsiella Pneumoniae infection on kidney transplantation recipients. BMC Nephrol 2022; 23:101. [PMID: 35287599 PMCID: PMC8919621 DOI: 10.1186/s12882-022-02733-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 03/09/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Infections remain a major cause of morbidity and mortality in kidney transplant (KT) recipients. This study aimed to investigate the preservation fluid (PF) samples from deceased donors and report the impacts of possible donor-derived carbapenem-resistant Klebsiella pneumoniae (pdd-CRKP) infections on KT recipients. METHODS A retrospective study was performed that included all recipients who received kidney transplantation from deceased donors in our hospital between December 2018 and December 2020. A total of 212 patients received kidney transplantation from deceased donors, a total of 206 PF samples were collected, and 20 recipients had a CRKP-positive culture. Both donors and recipients with CRKP-positive PF cultures were divided into two groups, and continuous variables between the two groups were compared using independent-sample t tests and Mann-Whitney tests. Categorical variables were compared using the chi-square test or Fisher's exact test. The significance level of p values was set at 0.05. RESULTS A total of 337 recipients underwent kidney transplantation, including 212 recipients of organs from deceased donors and 110 corresponding deceased donors. A total of 206 PF samples were collected, and 20 recipients had CRKP-positive PF cultures. The donors' length of ICU stay was a potential risk factor for CRKP positivity in the PF culture (P < 0.05). Fifteen recipients were infected with pdd-CRKP, and the incidence of pdd-CRKP infection was 7.3% (15/206). The use of antibiotics, including ceftazidime-avibactam (CAZ-AVI), was a potential protective factor against death and graft loss in recipients with a CRKP-positive PF culture (P < 0.05). CONCLUSIONS This study shows that the incidence of pdd-CRKP is high in our centre, recipients with pdd-CRKP infection can still achieve a good prognosis with the use of antimicrobial agents including CAZ-AVI.
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Affiliation(s)
- Fei Zhang
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China.,Institute of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, Anhui Province, China
| | - Jinbiao Zhong
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China.,Institute of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, Anhui Province, China
| | - Handong Ding
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China.,Institute of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China.,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, Anhui Province, China
| | - Guiyi Liao
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China. .,Institute of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China. .,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, Anhui Province, China.
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6
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Xiao J, Wu D, Jia Y, Wan Q, Peng J. Impact of Donor-Derived Multi-drug-Resistant Organism Infections on Abdominal Solid Organ Transplantation Recipients in China. Transplant Proc 2021; 53:1853-1857. [PMID: 33994182 DOI: 10.1016/j.transproceed.2021.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/05/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Infection with multi-drug-resistant organisms (MDROs) is a life-threatening disease among abdominal solid organ transplantation recipients. Reports of donor-derived (DD) MDRO infections were few, but adverse clinical outcomes were severe, such as death or graft loss. METHODS The medical records of 68 donation after citizens' death donors with MDRO infections and 20 recipients transmitted with infections between October 1, 2015, and September 1, 2020, were reviewed according to the Declaration of Helsinki and the Declaration of Istanbul. There were no grafts from prisoners, and no donors were not coerced or paid. RESULTS Prevalence and mortality of DD-MDRO infection among abdominal solid organ transplantation recipients were 2.3% and 18.1%, respectively. The prevalence rate of DD-MDR gram-negative bacterial infection was higher than that of gram-positive bacterial infection (1.7% vs 0.6%). Negative culture of specimens occurred in 9 of 68 donors. Recipients with DD-MDR gram-negative bacterial infections had a significantly lower survival rate compared with DD-MDR gram-positive bacterial infections (P = .046). CONCLUSIONS Donation after citizens' death donors and recipients had high MDRO infection rates, and gram-negative bacteria were the predominant pathogens. When a possible DD-MDRO infection occurs, there may be adverse outcomes with limited choice of antibiotics. A nationwide surveillance and communication network needs to be established in China.
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Affiliation(s)
- Jie Xiao
- Emergency Department, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Di Wu
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
| | - Yan Jia
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
| | - QiQuan Wan
- Transplantation Center, the Third Xiangya Hospital, Central South University, Changsha, China.
| | - Jie Peng
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China.
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Effects of Multidrug-resistant Bacteria in Donor Lower Respiratory Tract on Early Posttransplant Pneumonia in Lung Transplant Recipients Without Pretransplant Infection. Transplantation 2020; 104:e98-e106. [PMID: 31895333 DOI: 10.1097/tp.0000000000003102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Multidrug-resistant (MDR) bacteria in the lower respiratory tracts of allografts may be risk factors for early posttransplant pneumonia (PTP) that causes detrimental outcomes in lung transplant recipients (LTRs). We evaluated the effects of immediate changes in MDR bacteria in allografts on early PTP and mortality rates in LTRs. METHODS We reviewed 90 adult bilateral LTRs without pretransplant infections who underwent lung transplantation between October 2012 and May 2018. Quantitative cultures were performed with the bronchoalveolar lavage fluids of the allografts preanastomosis and within 3 days posttransplant. The International Society for Heart and Lung Transplantation consensus defines early PTP as pneumonia acquired within 30 days posttransplant and not associated with acute rejection. RESULTS MDR Acinetobacter baumannii (11/34, 32.4%) and Staphylococcus aureus (9/34, 26.5%) were identified in 24.4% (22/90) of the preanastomosis allografts. Four LTRs had the same MDR bacteria in allografts preanastomosis and posttransplant. Allograft MDR bacteria disappeared in 50% of the LTRs within 3 days posttransplant. Early PTP and all-cause in-hospital mortality rates were not different between LTRs with and without preanastomosis MDR bacteria (P = 0.75 and 0.93, respectively). MDR bacteria ≥10 CFU/mL in the lungs within 3 days posttransplant was associated with early PTP (odds ratio, 5.8; 95% confidence interval, 1.3-27.0; P = 0.03). CONCLUSIONS High levels of preexisting MDR bacteria in allografts did not increase early PTP and mortality rates in LTRs. Despite the small and highly selective study population, lung allografts with MDR bacteria may be safely transplanted with appropriate posttransplant antibiotic therapy.
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Impact of donor lung colonized bacteria detected by next-generation sequencing on early post-transplant outcomes in lung transplant recipients. BMC Infect Dis 2020; 20:689. [PMID: 32957986 PMCID: PMC7507255 DOI: 10.1186/s12879-020-05393-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 09/02/2020] [Indexed: 12/12/2022] Open
Abstract
Background The effect of donor lung colonized bacteria on the prognosis of lung transplantation is not clear. We used the technique of next-generation sequencing (NGS) to detect the colonized bacteria from the lower respiratory tract and analyzed whether the colonized bacteria of donor lung could affect the outcomes of lung transplantation. Methods Seventeen patients who underwent lung transplantation from March 2018 to June 2018 at Wuxi People’s Hospital affiliated to Nanjing Medical University were included in this study. Twelve cases of donor lung were obtained, and 17 lung transplants were performed, including 12 single lung transplantation and 5 bilateral lung transplantation. The colonized bacteria in the lower lobe tissue of donor lung were detected by NGS, and the bacteria culture method was used to detect the bacteria in the airway secretion before and after the operation. The information of length of extracorporeal membrane oxygenation (ECMO) support, mechanical ventilation time, length of intensive care unit (ICU) stay, duration of fever and length of hospital stay were collected for prognostic analysis. Results Compared with bacterial culture methods, the positive rate by using NGS in the lungs were higher (52.9% vs 41.2%). Among the patients who were transplanted with donor lungs with detected bacteria by NGS before surgery, only one patient (1/9) developed the same bacteria after lung transplantation. Based on results of NGS and bacterial culture, there was no association between the colonized bacteria in donor lungs and the patients’ outcomes of immediate posttransplant period. Conclusion NGS showed more sensitive than bacterial culture for detection of bacteria. The colonized bacteria in different parts of the lung are inconsistent. There is no association between the colonized bacteria in donor lungs and short-term outcome of lung transplantation patients.
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Anesi JA, Han JH, Lautenbach E, Lee DH, Clauss H, Climaco A, Bilker WB, Hasz R, Molnar E, Alimenti D, West S, Tolomeo P, Blumberg EA, CDC Prevention Epicenters Program. Impact of deceased donor multidrug-resistant bacterial organisms on organ utilization. Am J Transplant 2020; 20:2559-2566. [PMID: 32090413 PMCID: PMC7483863 DOI: 10.1111/ajt.15830] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/04/2020] [Accepted: 02/20/2020] [Indexed: 01/25/2023]
Abstract
The extent to which donor multidrug-resistant organisms (MDROs) affect organ utilization remains unclear. We performed a retrospective cohort study at 4 transplant centers between 2015 and 2016 to evaluate this question. All deceased donors who donated at least one organ were included. Exposed donors had at least one MDRO on culture. Unexposed donors had no MDRO-positive cultures. Only cultures obtained during the donor's terminal hospitalization were evaluated. Multivariable regression was used to determine the association between donor MDRO and (1) number of organs transplanted per donor and (2) the match run at which each organ was accepted. Subsequently, we restricted the analysis to donors with MDR-Gram-negative (GN) organisms. Of 440 total donors, 29 (7%) donors grew MDROs and 7 (2%) grew MDR-GNs. There was no significant association between donor MDRO and either measure of organ utilization. However, donor MDR-GNs were associated with a significant reduction in the number of organs transplanted per donor (incidence rate ratio 0.43, 95% confidence interval [CI] 0.39-0.48, P < .01), and organs were accepted significantly further down the match list (relative count 5.08, 95% CI 1.64-15.68, P = .01). Though donor MDR-GNs were infrequent in our study, their growing prevalence could meaningfully reduce the donor pool over time.
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Affiliation(s)
- Judith A. Anesi
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA;,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Ebbing Lautenbach
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA;,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA;,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Dong Heun Lee
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA
| | - Heather Clauss
- Section of Infectious Diseases, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Antonette Climaco
- Division of Infectious Diseases, Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA
| | - Warren B. Bilker
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA;,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Richard Hasz
- Gift of Life Donor Program, Philadelphia, PA, USA
| | - Esther Molnar
- Section of Infectious Diseases, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Darcy Alimenti
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA;,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sharon West
- Gift of Life Donor Program, Philadelphia, PA, USA
| | - Pam Tolomeo
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA;,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Emily A. Blumberg
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Donor-Derived Disease Transmission in Lung Transplantation. CURRENT PULMONOLOGY REPORTS 2020. [DOI: 10.1007/s13665-020-00245-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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11
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Procaccio F, Masiero L, Vespasiano F, Grossi PA, Gagliotti C, Pantosti A, Caprio M, Lombardini L, Nanni Costa A, Giacon B, Saracino A, Mancini P, Giannattasio P, Sangiorgi G, Licari M, Valeri M, Munoz Lopez M, Moschini M, Giacometti R, Panebianco A, Littera R, Butera A, Bonizzoli M, Pilati L, Dovas A, Lazzarini F, Coluccio E, Vesconi S, Ghirardini A, Puoti F, Ricci A, Di Ciaccio P. Organ donor screening for carbapenem-resistant gram-negative bacteria in Italian intensive care units: the DRIn study. Am J Transplant 2020; 20:262-273. [PMID: 31400257 DOI: 10.1111/ajt.15566] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 08/01/2019] [Accepted: 08/03/2019] [Indexed: 01/25/2023]
Abstract
The 759 cases of brain death declaration (BDD [Italian law, 6 hours of observation time]) that occurred in 190 Italian intensive care units (ICUs) between May and September 2012 were studied to quantify carbapenem-resistant gram-negative bacteria (CR-GN) isolated in organ donors, to evaluate adherence to national screening guidelines, and to identify risk factors for CR-GN isolation. Mandatory blood, bronchoalveolar lavage, and urine cultures were performed on the BDD day in 99% of used donors. Because results were rarely made available before transplant, >20% of transplants were performed before obtaining any microbiological information, and organs from 15 of 22 CR-GN cases were used. Two (lung-liver) of the 37 recipients died, likely because of donor-derived early CR-GN sepsis. ICU stay >3 days (odds ratio [OR] = 7.49, P = .004), fever (OR = 3.11, P = .04), age <60 years (OR = 2.80, P = .06), and positive ICU epidemiology (OR = 8.77, P = .07) were associated with CR-GN isolation. An association between single ICU and risk of CR-GN was observed, as a result of differences across ICUs (ICC = 29%; 95% confidence interval [CI] 6.5%-72%) probably related to inadequate practices of infection control. Continuous education aimed at implementing priority actions, including stewardship programs for a rational use of antimicrobials, is a priority in healthcare systems and transplant networks. Improved awareness among ICU personnel regarding the importance of early CR-GN detection and timely alert systems might facilitate decisions regarding organ suitability and eventually save recipient lives.
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Affiliation(s)
| | - Lucia Masiero
- Centro Nazionale Trapianti, Istituto Superiore di Sanità, Rome, Italy
| | | | - Paolo A Grossi
- Clinica delle Malattie Infettive e Tropicali, Università degli Studi dell'Insubria, Varese, Italy
| | - Carlo Gagliotti
- Agenzia Sanitaria e Sociale Regionale Emilia-Romagna, Bologna, Italy
| | - Annalisa Pantosti
- Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
| | - Mario Caprio
- Centro Nazionale Trapianti, Istituto Superiore di Sanità, Rome, Italy
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12
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Bunsow E, Los-Arcos I, Martin-Gómez MT, Bello I, Pont T, Berastegui C, Ferrer R, Nuvials X, Deu M, Peghin M, González-López JJ, Lung M, Román A, Gavaldà J, Len O. Donor-derived bacterial infections in lung transplant recipients in the era of multidrug resistance. J Infect 2019; 80:190-196. [PMID: 31843689 DOI: 10.1016/j.jinf.2019.12.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/08/2019] [Accepted: 12/09/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Our aim was to analyze the prevalence of multidrug-resistant bacterial infections in lung transplant donors and to evaluate its influence on donor-derived bacterial infections. METHODS We conducted a retrospective study of adult patients who underwent lung transplantation (2013-2016) at our hospital. Donor-derived bacterial infection was defined as the isolation of the same bacteria with identical antibiotic susceptibility patterns in the recipient and the perioperative cultures from the donor during the first month posttransplantation. We utilized a preventive antibiotic strategy adapted to the bacteria identified in donor cultures using systemic and nebulized antibiotics. RESULTS 252 lung transplant recipients and 243 donors were included. In 138/243 (56.8%) donors, one bacterial species was isolated from at least one sample; graft colonization (118/243; 48.6%), blood cultures (5/243; 2.1%) and the contamination of preservation fluids (56/243; 23%). Multidrug-resistant bacteria were isolated from 12/243 (4.9%) donors; four Enterobacterales, four Stenotrophomonas maltophilia, three Pseudomonas aeruginosa and one methicillin-resistant Staphylococcus aureus. There was no transmission of these multidrug-resistant bacteria. Donor-derived infections, primarily tracheobronchitis due to non-MDR bacteria, were diagnosed in 7/253 (2.9%) recipients, with good clinical outcomes. CONCLUSIONS The lungs of donors colonized with multidrug-resistant bacteria may be safely used when recipients receive prompt tailored antibiotic treatment.
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Affiliation(s)
| | - Ibai Los-Arcos
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain.
| | | | - Irene Bello
- Thoracic Surgery Deparment, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Teresa Pont
- Transplant Coordination Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Ricard Ferrer
- Critical Care Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Xavier Nuvials
- Critical Care Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - María Deu
- Thoracic Surgery Deparment, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Maddalena Peghin
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan José González-López
- Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Microbiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mayli Lung
- Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Microbiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Antonio Román
- Lung Transplant Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Joan Gavaldà
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - Oscar Len
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain
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13
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Snyman Y, Whitelaw AC, Reuter S, Dramowski A, Maloba MRB, Newton-Foot M. Clonal expansion of colistin-resistant Acinetobacter baumannii isolates in Cape Town, South Africa. Int J Infect Dis 2019; 91:94-100. [PMID: 31765820 DOI: 10.1016/j.ijid.2019.11.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/17/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES To describe colistin-resistant Acinetobacter baumannii isolates in Cape Town, South Africa. METHODS A. baumannii isolates identified on Vitek 2 Advanced Expert System were collected from Tygerberg Hospital referral laboratory between 2016 and 2017. Colistin resistance was confirmed using broth microdilution and SensiTest. mcr-1-5 were detected using PCR and strain typing was performed by rep-PCR. Whole genome sequencing (WGS) was performed on a subset of isolates to identify chromosomal colistin resistance mechanisms and strain diversity using multilocus sequence typing (MLST) and pairwise single nucleotide polymorphism analyses. RESULTS Twenty-six colistin-resistant and six colistin-susceptible A. baumannii were collected separately based on Vitek susceptibility; 20/26 (77%) were confirmed colistin-resistant by broth microdilution. Four colistin-resistant isolates were isolated in 2016 and 16 in 2017, from five healthcare facilities. Thirteen colistin-resistant isolates and eight colistin-susceptible isolates were identical by rep-PCR and MLST (ST1), all from patients admitted to a tertiary hospital during 2017. The remaining colistin-resistant isolates were unrelated. CONCLUSIONS An increase in colistin-resistant A. baumannii isolates from a tertiary hospital in 2017 appears to be clonal expansion of an emerging colistin-resistant strain. This strain was not detected in 2016 or from other hospitals. Identical colistin-susceptible isolates were also isolated, suggesting relatively recent acquisition of colistin resistance.
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Affiliation(s)
- Yolandi Snyman
- Division of Medical Microbiology, Department of Pathology, Stellenbosch University, Cape Town, South Africa.
| | - Andrew Christopher Whitelaw
- Division of Medical Microbiology, Department of Pathology, Stellenbosch University, Cape Town, South Africa; National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Sandra Reuter
- Institute for Infection Prevention and Hospital Epidemiology, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Motlatji Reratilwe Bonnie Maloba
- Department of Medical Microbiology, University of the Free State, Bloemfontein, South Africa; National Health Laboratory Service, Universitas Hospital, Bloemfontein, South Africa
| | - Mae Newton-Foot
- Division of Medical Microbiology, Department of Pathology, Stellenbosch University, Cape Town, South Africa; National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
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14
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Smibert O, Satlin MJ, Nellore A, Peleg AY. Carbapenem-Resistant Enterobacteriaceae in Solid Organ Transplantation: Management Principles. Curr Infect Dis Rep 2019; 21:26. [PMID: 31183574 DOI: 10.1007/s11908-019-0679-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Carbapenem-resistant Enterobacteriaceae (CRE) have emerged as a worldwide problem. Given their degree of immunosuppression and the level of contact with the healthcare system, solid organ transplant (SOT) recipients are at a disproportionately higher risk of acquisition, colonization, and infection with CRE, and outcomes from infection tend to be worse compared to non-transplant patients. Therapeutic options are limited for CRE infections although several newer agents have recently been approved for use. How well these agents perform in the setting of immunosuppression and SOT is unclear. We sought to review the epidemiology of CRE in SOT and the management principles. RECENT FINDINGS CRE infections are becoming an increasing problem in SOT, and donor-derived infections present a challenge in the peri-transplant period. Newer treatments for CRE are emerging that are less toxic and potentially more effective than prior CRE-active agents, but supportive clinical data are limited. Newer beta-lactamase inhibitors have good activity against KPC carbapenemases, but they lack activity against metallo-beta-lactamases (e.g., NDM). Promising data is emerging with newer agents that have activity against most carbapenemases, but, again, clinical data is needed. Combination therapy in addition to optimal pharmacokinetic and pharmacodynamics may go some way to improve outcomes against these difficult-to-treat organisms. Other novel therapies that prevent the emergence of resistance (oral beta-lactamase inhibitors) and eradication of resistant Gram-negative colonization (fecal microbiota transplant) may eventually become part of a bundle approach to reduce CRE infections in the future. As in non-transplant patients, CRE infections in the transplant setting are challenging to treat and prevent. Infection prevention and control remains crucial to prevent widespread dissemination, and unique challenges exist with donor-derived CRE and how best to manage recipients in the peri-transplant period. Newer treatments are now in early-phase clinical studies, and in vitro activity data are supportive for several agents providing hope for improved outcomes with these typically difficult-to-treat and highly morbid infections in transplant recipients.
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Affiliation(s)
- Olivia Smibert
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, Australia
- Transplant Infectious Disease and Compromised Host Program, Massachusetts General Hospital, Boston, MA, USA
| | - Michael J Satlin
- Division of Infectious Diseases, Weill Cornell Medicine, 1300 York Avenue, New York, NY, USA
| | - Anoma Nellore
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anton Y Peleg
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, Australia.
- Infection and Immunity Program, Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, VIC, Australia.
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15
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Wolfe CR, Ison MG. Donor-derived infections: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13547. [PMID: 30903670 DOI: 10.1111/ctr.13547] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/18/2019] [Indexed: 12/12/2022]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation will review the current state of the art of donor-derived infections. Specifically, the guideline will summarize standardized definitions and approaches to defining imputability, updated data on the epidemiology of donor-derived infections, and approaches to risk mitigation against transmission of infections. This update will additionally provide guidance on the use of HIV+ donors in HIV+ recipients, the use of HCV-viremic donors in non-viremic recipients, donors with endemic infections, and donors with bacteremia, meningitis, and encephalitis. Lastly, the guidance will summarize an approach to recipients with a suspected donor-derived infection.
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Affiliation(s)
- Cameron R Wolfe
- Division of Infectious Diseases, Duke University, Durham, North Carolina
| | - Michael G Ison
- Divisions of Infectious Diseases & Organ Transplantation, Northwestern University Feinberg School of Medicine, Northwestern University Comprehensive Transplant Center, Chicago, Illinois
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16
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White SL, Rawlinson W, Boan P, Sheppeard V, Wong G, Waller K, Opdam H, Kaldor J, Fink M, Verran D, Webster A, Wyburn K, Grayson L, Glanville A, Cross N, Irish A, Coates T, Griffin A, Snell G, Alexander SI, Campbell S, Chadban S, Macdonald P, Manley P, Mehakovic E, Ramachandran V, Mitchell A, Ison M. Infectious Disease Transmission in Solid Organ Transplantation: Donor Evaluation, Recipient Risk, and Outcomes of Transmission. Transplant Direct 2019; 5:e416. [PMID: 30656214 PMCID: PMC6324914 DOI: 10.1097/txd.0000000000000852] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 12/11/2022] Open
Abstract
In 2016, the Transplantation Society of Australia and New Zealand, with the support of the Australian Government Organ and Tissue authority, commissioned a literature review on the topic of infectious disease transmission from deceased donors to recipients of solid organ transplants. The purpose of this review was to synthesize evidence on transmission risks, diagnostic test characteristics, and recipient management to inform best-practice clinical guidelines. The final review, presented as a special supplement in Transplantation Direct, collates case reports of transmission events and other peer-reviewed literature, and summarizes current (as of June 2017) international guidelines on donor screening and recipient management. Of particular interest at the time of writing was how to maximize utilization of donors at increased risk for transmission of human immunodeficiency virus, hepatitis C virus, and hepatitis B virus, given the recent developments, including the availability of direct-acting antivirals for hepatitis C virus and improvements in donor screening technologies. The review also covers emerging risks associated with recent epidemics (eg, Zika virus) and the risk of transmission of nonendemic pathogens related to donor travel history or country of origin. Lastly, the implications for recipient consent of expanded utilization of donors at increased risk of blood-borne viral disease transmission are considered.
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Affiliation(s)
- Sarah L White
- Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - William Rawlinson
- Serology and Virology Division, NSW Health Pathology Prince of Wales Hospital, Sydney, Australia
- Women's and Children's Health and Biotechnology and Biomolecular Sciences, University of New South Wales Schools of Medicine, Sydney, Australia
| | - Peter Boan
- Departments of Infectious Diseases and Microbiology, Fiona Stanley Hospital, Perth, Australia
- PathWest Laboratory Medicine, Perth, Australia
| | - Vicky Sheppeard
- Communicable Diseases Network Australia, New South Wales Health, Sydney, Australia
| | - Germaine Wong
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Karen Waller
- Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Helen Opdam
- Austin Health, Melbourne, Australia
- The Organ and Tissue Authority, Australian Government, Canberra, Australia
| | - John Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Michael Fink
- Austin Health, Melbourne, Australia
- Department of Surgery, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Deborah Verran
- Transplantation Services, Royal Prince Alfred Hospital, Sydney, Australia
| | - Angela Webster
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Kate Wyburn
- Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia
- Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Lindsay Grayson
- Austin Health, Melbourne, Australia
- Department of Surgery, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Allan Glanville
- Department of Thoracic Medicine and Lung Transplantation, St Vincent's Hospital, Sydney, Australia
| | - Nick Cross
- Department of Nephrology, Canterbury District Health Board, Christchurch Hospital, Christchurch, New Zealand
| | - Ashley Irish
- Department of Nephrology, Fiona Stanley Hospital, Perth, Australia
- Faculty of Health and Medical Sciences, UWA Medical School, The University of Western Australia, Crawley, Australia
| | - Toby Coates
- Renal and Transplantation, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Anthony Griffin
- Renal Transplantation, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Greg Snell
- Lung Transplant, Alfred Health, Melbourne, Victoria, Australia
| | - Stephen I Alexander
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Scott Campbell
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Steven Chadban
- Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia
- Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Peter Macdonald
- Department of Cardiology, St Vincent's Hospital, Sydney, Australia
- St Vincent's Hospital Victor Chang Cardiac Research Institute, University of New South Wales, Sydney, Australia
| | - Paul Manley
- Kidney Disorders, Auckland District Health Board, Auckland City Hospital, Auckland, New Zealand
| | - Eva Mehakovic
- The Organ and Tissue Authority, Australian Government, Canberra, Australia
| | - Vidya Ramachandran
- Serology and Virology Division, NSW Health Pathology Prince of Wales Hospital, Sydney, Australia
| | - Alicia Mitchell
- Department of Thoracic Medicine and Lung Transplantation, St Vincent's Hospital, Sydney, Australia
- Woolcock Institute of Medical Research, Sydney, Australia
- School of Medical and Molecular Biosciences, University of Technology, Sydney, Australia
| | - Michael Ison
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL
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18
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Ahmad O, Shafii AE, Mannino DM, Choate R, Baz MA. Impact of donor lung pathogenic bacteria on patient outcomes in the immediate post-transplant period. Transpl Infect Dis 2018; 20:e12986. [PMID: 30171789 DOI: 10.1111/tid.12986] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/31/2018] [Accepted: 08/05/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patient outcomes post-lung transplant remain inferior to other types of solid organ transplantation. We investigated whether the presence of potentially pathogenic bacteria (PPB) in donor lung bronchial cultures was associated with adverse outcomes postoperatively. METHODS All patients who underwent lung transplantation between August 2015 and April 2017 at the University of Kentucky Medical Center were retrospectively reviewed. Retransplants, patients with bronchiectasis (including cystic fibrosis), and individuals who received organs from donation after cardiac death (DCD) donors were excluded. The remaining subjects were separated into two groups: individuals whose donor bronchial cultures grew PPB, and those whose cultures either returned negative for PPB or were sterile. 30-day mortality rates as well as the incidence of grade 3 primary graft dysfunction (PGD) and acute kidney injury (AKI) at both 24 and 72 hours post-transplant were calculated. The duration of mechanical ventilation postoperatively was also recorded. RESULTS Thirty two subjects comprised the study population. 20 patients (63%) had growth of PPB on donor cultures, while 12 (37%) did not. Patients with PPB had a significantly greater number of days on the ventilator postoperatively compared to those with no PPB (mean = 11.3 and median = 5.0 vs mean = 5.8 and median = 3.0, respectively, P = 0.0232). Subsequent regression analysis revealed this association to not be influenced by recipient lung allocation score (LAS), donor age, donor smoking history, recipient mean pulmonary artery pressure (mPAP) value, and/or use of cardiopulmonary bypass at the time of transplantation. Neither 30-day survival nor incidence of Grade 3 PGD and AKI at 24 or 72 hours post-transplant differed between the two groups (P > 0.05). CONCLUSION The recovery of PPB in donor lung cultures was associated with a longer duration of mechanical ventilation postoperatively in lung transplant recipients.
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Affiliation(s)
- Omar Ahmad
- Division of Infectious Diseases, University of Kentucky, Lexington, Kentucky
| | - Alexis E Shafii
- Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky
| | - David M Mannino
- Department of Preventative Medicine and Environmental Health, University of Kentucky, Lexington, Kentucky
| | - Radmila Choate
- Department of Preventative Medicine and Environmental Health, University of Kentucky, Lexington, Kentucky
| | - Maher A Baz
- Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky
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19
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Multidrug-Resistant Bacterial Infections in Solid Organ Transplant Candidates and Recipients. Infect Dis Clin North Am 2018; 32:551-580. [DOI: 10.1016/j.idc.2018.04.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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20
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Royer S, de Campos PA, Araújo BF, Ferreira ML, Gonçalves IR, Batistão DWDF, Brígido RTES, Cerdeira LT, Machado LG, de Brito CS, Gontijo-Filho PP, Ribas RM. Molecular characterization and clonal dynamics of nosocomial blaOXA-23 producing XDR Acinetobacter baumannii. PLoS One 2018; 13:e0198643. [PMID: 29889876 PMCID: PMC5995351 DOI: 10.1371/journal.pone.0198643] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/22/2018] [Indexed: 01/28/2023] Open
Abstract
The emergence of infections associated to new antimicrobial resistance in Acinetobacter baumannii (Ab) genotypes represents a major challenge. In this context, this study aimed to determine the diversity of resistance mechanisms and investigate clonal dissemination and predominant sequence types (STs) in multidrug-resistant Ab strains of clinical (tracheal aspirate, n = 17) and environmental (surface, n = 6) origins. Additionally, the major clones found in clinical (A) and environmental (H) strains had their complete genomes sequenced. All strains were submitted to polymerase chain reactions (PCR) for the detection of the ISAba1/blaOXA-51-like and ISAba1/blaOXA-23-like genes, while the expression of genes encoding the carO porin, AdeABC (adeB), AdeFGH (adeG), and AdeIJK (adeJ) efflux pumps was determined by real time PCR (qPCR). Most of the strains were characterized as extensively drug-resistant (XDR) with high minimal inhibitory concentrations (MICs) detected for tigecycline and carbapenems. Associations between ISAba1/OXA-51 and ISAba1/OXA-23 were observed in 91.3% and 52.2% of the strains, respectively. Only the adeB gene was considered hyper-expressed. Furthermore, most of the strains analyzed by the MuLtilocus Sequence-Typing (MLST) were found to belong to the clonal complex 113 (CC113). In addition, a new ST, ST1399, belonging to CC229, was also discovered herein. Strains analyzed by whole genome sequencing presented resistance genes linked to multidrug-resistance phenotypes and confirmed the presence of Tn2008, which provides high levels carbapenem-resistance.
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Affiliation(s)
- Sabrina Royer
- Institute of Biomedical Sciences (ICBIM), Laboratory of Molecular Microbiology, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
- * E-mail:
| | - Paola Amaral de Campos
- Institute of Biomedical Sciences (ICBIM), Laboratory of Molecular Microbiology, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Bruna Fuga Araújo
- Institute of Biomedical Sciences (ICBIM), Laboratory of Molecular Microbiology, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Melina Lorraine Ferreira
- Institute of Biomedical Sciences (ICBIM), Laboratory of Molecular Microbiology, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Iara Rossi Gonçalves
- Institute of Biomedical Sciences (ICBIM), Laboratory of Molecular Microbiology, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | | | - Rebecca Tavares e Silva Brígido
- National Reference Center for Sanitary Dermatology and Leprosy (CREDESH) Clinical Hospital Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | | | - Luiz Gustavo Machado
- Institute of Biomedical Sciences (ICBIM), Laboratory of Molecular Microbiology, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Cristiane Silveira de Brito
- Institute of Biomedical Sciences (ICBIM), Laboratory of Molecular Microbiology, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Paulo Pinto Gontijo-Filho
- Institute of Biomedical Sciences (ICBIM), Laboratory of Molecular Microbiology, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Rosineide Marques Ribas
- Institute of Biomedical Sciences (ICBIM), Laboratory of Molecular Microbiology, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
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21
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Infections in liver and lung transplant recipients: a national prospective cohort. Eur J Clin Microbiol Infect Dis 2018; 37:399-407. [PMID: 29380226 DOI: 10.1007/s10096-018-3183-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/02/2018] [Indexed: 12/11/2022]
Abstract
Infections are a major complication of solid organ transplants (SOTs). This study aimed to describe recipients' characteristics, and the frequency and etiology of infections and transplant outcome in liver and lung SOTs, and to investigate exposures associated to infection and death in liver transplant recipients. The study population included recipients of SOTs performed in Italy during a 1-year period in ten Italian lung transplant units and eight liver transplant units. Data on comorbidities, infections, retransplantation, and death were prospectively collected using a web-based system, with a 6-month follow-up. The cumulative incidence of infection was 31.7% and 47.8% in liver and lung transplants, respectively, with most infections occurring within the first month after transplantation. Gram-negatives, which were primarily multidrug-resistant, were the most frequent cause of infection. Death rates were 0.42 per 1000 recipient-days in liver transplants and 1.41 per 1000 recipient-days in lung transplants. Infection after SOT in adult liver recipients is associated to an increased risk of death (OR = 13.25; p-value < 0.001). Given the frequency of infection caused by multidrug-resistant microorganisms in SOT recipients in Italy and the heavy impact of infections on the transplant outcome, the reinforcement of surveillance and control activities to prevent the transmission of multidrug-resistant microorganisms in SOT recipients represents a priority. The implementation of the study protocol in liver and lung transplant units and the sharing of results have increased the awareness about the threat due to antimicrobial resistance in the country.
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Perioperative Antibiotic Prophylaxis to Prevent Surgical Site Infections in Solid Organ Transplantation. Transplantation 2018; 102:21-34. [DOI: 10.1097/tp.0000000000001848] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Ye QF, Zhou W, Wan QQ. Donor-derived infections among Chinese donation after cardiac death liver recipients. World J Gastroenterol 2017; 23:5809-5816. [PMID: 28883707 PMCID: PMC5569296 DOI: 10.3748/wjg.v23.i31.5809] [Citation(s) in RCA: 13] [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: 03/20/2017] [Revised: 06/27/2017] [Accepted: 07/22/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate blood cultures of deceased donors and report the confirmed transmission of bacterial infection from donors to liver recipients. METHODS We retrospectively studied the results of blood cultures among our donation after cardiac death (DCD) donors and calculated the donor-derived bacterial infection rates among liver recipients. Study participants underwent liver transplantation between January 1, 2010 and February 1, 2017. The study involved a total of 67 recipients of liver grafts from 67 DCD donors. We extracted the data of donors' and patients' characteristics, culture results and clinical outcomes, especially the post-transplant complications in liver recipients, from electronic medical records. We analyzed the characteristics of the donors and the corresponding liver recipients with emphasis put on donor-derived infections. RESULTS Head trauma was the most common origin of death among our 67 DCD donors (46.3%). Blood taken prior to the procurement operation was cultured for 53 of the donors, with 17 episodes of bloodstream infections developing from 13 donors. The predominant organism isolated from the blood of donors was Gram-positive bacteria (70.6%). Only three (4.5%) of 67 liver recipients developed confirmed donor-derived bacterial infections, with two isolates of multidrug-resistant Klebsiella pneumoniae and one isolate of multidrug-resistant Enterobacter aerogenes. The liver recipients with donor-derived infections showed relation to higher crude mortality and graft loss rates (33.3% each) within 3 mo post transplantation, as compared to those without donor-derived infections (9.4% and 4.7%, respectively). All three liver recipients received appropriate antimicrobial therapy. CONCLUSION Liver recipients have high occurrence of donor-derived infections. The liver recipients with donor-derived multidrug-resistant Enterobacteriaceae infections can have good outcome if appropriate antimicrobial therapy is given.
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Affiliation(s)
- Qi-Fa Ye
- Department of Transplant Surgery, the Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
- Department of Transplant Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
| | - Wei Zhou
- Department of Transplant Surgery, the Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
| | - Qi-Quan Wan
- Department of Transplant Surgery, the Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
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Escolà-Vergé L, Los-Arcos I, José González-López J, Lung M, Bilbao I, Farré M, Pont T, Sandiumenge A, Gavaldà J, Len O. Successful liver transplantation despite donor-transmitted ESBL-producing Klebsiella pneumoniae infection: Case report and review of the literature. Transpl Infect Dis 2017; 19. [PMID: 28691772 DOI: 10.1111/tid.12743] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 03/20/2017] [Accepted: 04/09/2017] [Indexed: 01/02/2023]
Abstract
Donor-derived bacterial infection is a recognized complication of solid organ transplantation. Patients admitted to the intensive care unit are increasingly exposed to infection with multidrug-resistant microorganisms. However, no specific recommendations are available about their suitability as donors. We report a case of donor-transmitted extended-spectrum beta-lactamase-producing Klebsiella pneumoniae infection in a liver recipient, and review the related literature.
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Affiliation(s)
- Laura Escolà-Vergé
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ibai Los-Arcos
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Mayli Lung
- Microbiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Itxarone Bilbao
- Department of Hepatopancreatobiliary Surgery and Transplants, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mercè Farré
- Critical Care Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Teresa Pont
- Medical Transplant Coordination Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Alberto Sandiumenge
- Medical Transplant Coordination Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Joan Gavaldà
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Oscar Len
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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25
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Kroth LV, Barreiro FF, Saitovitch D, Traesel MA, d'Avila DOL, Poli-de-Figueiredo CE. Does Thymoglobulin Induction Increase Susceptibility to Carbapenem-Resistant Acinetobacter baumannii Sepsis-related Death in Expanded Criteria Donors? Transplant Proc 2016; 48:2294-2297. [PMID: 27742282 DOI: 10.1016/j.transproceed.2016.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Solid organ transplant recipients are susceptible to antibiotic-resistant infections and carbapenem-resistant Acinetobacter baumannii (CRAB) has recently been recognized as a serious complication in solid organ recipients. High mortality rates have been described. METHODS We retrospectively analyzed 807 transplantations and detected 10 patients who died 24 hours after the diagnosis of septicemia, all with CRAB-positive blood cultures. Recipients were followed up for at least 1 year and were stratified into the following groups: Group 1, patients alive; Group 2, patients that died due to other causes except Acinetobacter infection; and Group 3, patients who died within 24 hours of CRAB diagnosis. RESULTS CRAB-positive patients died a median of 3.17 (range, 1.81-18.7) months after transplantation. In these patients, expanded criteria donors (ECDs) were more frequent (P < .001), as were the use of anti-thymocyte globulin (ATG) induction (P = .02) and delayed graft function (P = .01). For ECD recipients, death rate from any cause, whether induced with ATG or not, was 25% and 20.6%, respectively (odds ratio [OR], 1.28; confidence interval [CI] 95%, 0.56-2.91; P = .68). The death rate from CRAB-related sepsis was 10.3% and 0% whether receiving ATG or not, respectively (OR, 15.49; CI 95%, 0.87-277.16; P = .014). There was a 25.75-fold increase in the death rate in ECD kidney recipients induced with thymoglobulin and with CRAB-related sepsis. CONCLUSION Transplants from ECDs and induced with thymoglobulin may be at increased risk of CRAB death in 24 hours when compared with patients with standard donors and induced with thymoglobulin.
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Affiliation(s)
- L V Kroth
- Nephrology Unit, Hospital São Lucas da PUCRS, Programa de Pós-graduação em Medicina e Ciências da Saúde, Porto Alegre, Brazil.
| | - F F Barreiro
- Nephrology Unit, Hospital São Lucas da PUCRS, Programa de Pós-graduação em Medicina e Ciências da Saúde, Porto Alegre, Brazil
| | - D Saitovitch
- Nephrology Unit, Hospital São Lucas da PUCRS, Programa de Pós-graduação em Medicina e Ciências da Saúde, Porto Alegre, Brazil
| | - M A Traesel
- Nephrology Unit, Hospital São Lucas da PUCRS, Programa de Pós-graduação em Medicina e Ciências da Saúde, Porto Alegre, Brazil
| | - D O L d'Avila
- Nephrology Unit, Hospital São Lucas da PUCRS, Programa de Pós-graduação em Medicina e Ciências da Saúde, Porto Alegre, Brazil
| | - C E Poli-de-Figueiredo
- Nephrology Unit, Hospital São Lucas da PUCRS, Programa de Pós-graduação em Medicina e Ciências da Saúde, Porto Alegre, Brazil
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26
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Pfeifer Y, Trifonova A, Pietsch M, Brunner M, Todorova I, Gergova I, Wilharm G, Werner G, Savov E. Clonal Transmission of Gram-Negative Bacteria with Carbapenemases NDM-1, VIM-1, and OXA-23/72 in a Bulgarian Hospital. Microb Drug Resist 2016; 23:301-307. [PMID: 27459019 DOI: 10.1089/mdr.2016.0059] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We characterized 72 isolates with reduced susceptibility to carbapenems (50 Acinetobacter spp., 13 Proteus mirabilis, five Escherichia coli, one Morganella morganii, one Enterobacter cloacae, one Providencia rettgeri, and one Pseudomonas aeruginosa) from a hospital in Sofia, Bulgaria. Different β-lactamase genes were identified by polymerase chain reaction and sequencing. Bacterial strain typing was performed by enzymatic macrorestriction and pulsed-field gel electrophoresis (PFGE) typing as well as multilocus sequence typing for selected isolates. The majority of Acinetobacter baumannii (46/50) and one Acinetobacter pittii isolate harbored carbapenemase genes blaOXA-23 or blaOXA-72; two A. baumannii contained both genes. PFGE typing of all A. baumannii showed the presence of nine different clones belonging to eight sequence types ST350, ST208, ST436, ST437, ST449, ST231, ST502, and ST579. Molecular characterization of the remaining isolates confirmed the presence of one NDM-1-producing E. coli-ST101 clone (five isolates) and one P. mirabilis clone (13 isolates) with VIM-1 and CMY-99. Furthermore, NDM-1 was identified in P. rettgeri and M. morganii and VIM-2 in the P. aeruginosa isolate. The permanent introduction of OXA-23/72 carbapenemase-producing A. baumannii clones into the hospital and the repeated occurrence of one VIM-1-producing P. mirabilis and one NDM-1-producing E. coli-ST101 clone over a period of more than 1 year is of concern and requires intensified investigations.
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Affiliation(s)
- Yvonne Pfeifer
- 1 Robert Koch Institute , FG13 Nosocomial Pathogens and Antibiotic Resistance, Wernigerode, Germany
| | | | - Michael Pietsch
- 1 Robert Koch Institute , FG13 Nosocomial Pathogens and Antibiotic Resistance, Wernigerode, Germany
| | - Magdalena Brunner
- 1 Robert Koch Institute , FG13 Nosocomial Pathogens and Antibiotic Resistance, Wernigerode, Germany
| | | | | | - Gottfried Wilharm
- 3 Robert Koch Institute , P2 Acinetobacter baumannii, Wernigerode, Germany
| | - Guido Werner
- 1 Robert Koch Institute , FG13 Nosocomial Pathogens and Antibiotic Resistance, Wernigerode, Germany
| | - Encho Savov
- 2 Military Medical Academy , Sofia, Bulgaria
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27
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Whiddon AR, Dawson KL, Fuentes A, Perez KK, Peterson LE, Kaleekal T. Postoperative antimicrobials after lung transplantation and the development of multidrug-resistant bacterial andClostridium difficileinfections: an analysis of 500 non-cystic fibrosis lung transplant patients. Clin Transplant 2016; 30:767-73. [DOI: 10.1111/ctr.12746] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 12/25/2022]
Affiliation(s)
| | | | - Amaris Fuentes
- CHI St. Luke's Health - Baylor St. Luke's Medical Center; Houston TX USA
| | - Katherine K. Perez
- Houston Methodist Hospital; Houston TX USA
- Houston Methodist Research Institute; Houston TX USA
| | - Leif E. Peterson
- Houston Methodist Hospital; Houston TX USA
- Houston Methodist Research Institute; Houston TX USA
| | - Thomas Kaleekal
- Houston Methodist Hospital; Houston TX USA
- Houston Methodist Research Institute; Houston TX USA
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28
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Lewis JD, Sifri CD. Multidrug-Resistant Bacterial Donor-Derived Infections in Solid Organ Transplantation. Curr Infect Dis Rep 2016; 18:18. [PMID: 27115701 DOI: 10.1007/s11908-016-0526-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Although rare, donor-derived infections (DDIs) caused by multidrug-resistant (MDR) bacteria can have devastating consequences for organ transplant recipients. Recognition of MDR bacterial DDIs can be challenging, as MDR bacteria are prevalent in most hospitals and distinguishing their transmission through transplantation from other, more typical routes of acquisition are difficult. New technologies such as whole genome sequencing have recently proven to be a powerful advance in the investigation of MDR bacterial DDIs. Once recognized, the optimal treatment of MDR bacterial DDIs is not clear. Herein, we review the clinical manifestations, outcomes, and management of MDR bacterial DDIs, and identify areas of uncertainty toward which the transplant community should direct further research efforts.
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Affiliation(s)
- Jessica D Lewis
- Division of Infectious Diseases & International Health, University of Virginia Health System, P.O. Box 800473, Charlottesville, VA, 22908-0473, USA
| | - Costi D Sifri
- Division of Infectious Diseases & International Health, University of Virginia Health System, P.O. Box 800473, Charlottesville, VA, 22908-0473, USA.
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29
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Abstract
Solid-organ transplantation (SOT) has become the preferred strategy to treat a number of end-stage organ disease, because a continuous improvement in survival and quality of life. While preventive strategies has decreased the risk for classical opportunistic infections (such as viral, fungal and parasite infections), bacterial infections, and particularly bloodstream infections (BSIs) remain the most common and life-threatening complications in SOT recipients. The source of BSI after transplant depends on the type of transplantation, being urinary tract infection, pneumonia, and intraabdominal infections the most common infections occurring after kidney, lung and liver transplantation, respectively. The risk for candidemia is higher in abdominal-organ than in thoracic-organ transplantation. Currently, the increasing prevalence of multi-drug resistant (MDR) Gram-negative pathogens, such as extended-spectrum betalactamase-producing Enterobacteriaciae and carbapenem-resistant Klebsiella pneumoniae, is causing particular concerns in SOT recipients, a population which presents several risk factors for developing infections due to MDR organisms. The application of strict preventive policies to reduce the incidence of post transplant BSIs and to control the spread of MDR organisms, including the implementation of specific stewardship programs to avoid the overuse of antibiotics and antifungal drugs, are essential steps to reduce the impact of post transplant infections on allograft and patient outcomes.
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Affiliation(s)
- Antonios Kritikos
- a Infectious Diseases Service, University Hospital and University of Lausanne , Lausanne , Switzerland
| | - Oriol Manuel
- a Infectious Diseases Service, University Hospital and University of Lausanne , Lausanne , Switzerland.,b Transplantation Center, University Hospital and University of Lausanne , Lausanne , Switzerland
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30
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Huenges K, Reinecke A, Bewig B, Haneya A, Cremer J. Lung Transplantation in a Multidrug-Resistant Gram-Negative Acinetobacter Baumannii-Colonized Patient: A Case Report. Thorac Cardiovasc Surg Rep 2015; 5:16-17. [PMID: 28018813 PMCID: PMC5177446 DOI: 10.1055/s-0035-1569993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 10/19/2015] [Indexed: 11/09/2022] Open
Abstract
Colonization or infection with various pathogens is frequently found in patients listed for lung transplantation. We describe a case of a 50-year-old woman with α-1-antitrypsin deficiency, which was listed for double-lung transplantation, with multidrug-resistant gram-negative Acinetobacter baumannii (MRGN4-Ab) skin colonization. Transplantation was successfully performed. Colistin (Polymyxine E) was administered intravenously and through inhalation in the first month. MRGN4-Ab was still detectable in skin swabs without evidence of infection. After good recovery and clinical inapparence, the patient was discharged 2 months after transplantation.
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Affiliation(s)
- Katharina Huenges
- Department of Cardiovascular Surgery, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Alexander Reinecke
- Department of Cardiovascular Surgery, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Burkhard Bewig
- Department of Internal Medicine I, University of Schleswig Holstein Campus Kiel, Kiel, Germany
| | - Assad Haneya
- Department of Cardiovascular Surgery, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Jochen Cremer
- Department of Cardiovascular Surgery, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
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31
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Nie XM, Huang PH, Ye QF, Wan QQ. The Distribution, Drug Resistance, and Clinical Characteristics of Acinetobacter baumannii Infections in Solid Organ Transplant Recipients. Transplant Proc 2015; 47:2860-2864. [PMID: 26707303 DOI: 10.1016/j.transproceed.2015.09.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 09/24/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Acinetobacter baumannii has become a major problem among solid organ transplant (SOT) recipients. The aim of this study was to investigate the distribution, drug resistance, and clinical characteristics of A baumannii infections in SOT recipients. METHODS We retrospectively identified 78/1,850 (4.2%) SOT recipients who developed A baumannii infections from January 1, 2003, to April 1, 2015, and evaluated the distribution, drug resistance, and clinical characteristics of these infections. RESULTS Over the study period, 101 episodes of A baumannii infection occurred in 78 SOT recipients, with respiratory tract (37.6%) and blood (35.6%) as the most common sites of infection. Fifty-six episodes of A baumannii infection were accompanied with a serum creatinine level of >1.5 mg/dL. Multidrug resistance (MDR) or extensive drug resistance (XDR) occurred in 83.2%. Antibiotic resistance rate of all A baumannii to 8 of 9 antibiotics investigated was >50%. Seventy-eight percent of A baumannii were carbapenem-resistant. All but one A baumannii isolates tested against polymyxin B were susceptible. There were 40 (51.3%) overall in-hospital deaths and 31 (39.7%) infection-related deaths. CONCLUSIONS A baumannii infections are associated with high morbidity and mortality in SOT recipients, and MDR or XDR is common. Prevention measures are essential, and combination therapy of antibiotics are needed to improve the outcomes of SOT recipients with A baumannii infections.
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Affiliation(s)
- X M Nie
- Department of Clinical Laboratory, Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - P H Huang
- Department of Pharmacy, Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Q F Ye
- Department of Transplant Surgery, Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China; Department of Transplant Surgery, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Q Q Wan
- Department of Transplant Surgery, Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
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32
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Mularoni A, Bertani A, Vizzini G, Gona F, Campanella M, Spada M, Gruttadauria S, Vitulo P, Conaldi P, Luca A, Gridelli B, Grossi P. Outcome of Transplantation Using Organs From Donors Infected or Colonized With Carbapenem-Resistant Gram-Negative Bacteria. Am J Transplant 2015; 15:2674-82. [PMID: 25981339 DOI: 10.1111/ajt.13317] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 03/08/2015] [Accepted: 03/13/2015] [Indexed: 02/06/2023]
Abstract
Donor-derived infections due to multidrug-resistant bacteria are a growing problem in solid organ transplantation, and optimal management options are not clear. In a 2-year period, 30/214 (14%) recipients received an organ from 18/170 (10.5%) deceased donors with infection or colonization caused by a carbapenem-resistant gram-negative bacteria that was unknown at the time of transplantation. Among them, 14/30 recipients (47%) received a transplant from a donor with bacteremia or with infection/colonization of the transplanted organ and were considered at high risk of donor-derived infection transmission. The remaining 16/30 (53%) recipients received an organ from a nonbacteremic donor with colonization of a nontransplanted organ and were considered at low risk of infection transmission. Proven transmission occurred in 4 of the 14 high-risk recipients because donor infection was either not recognized, underestimated, or not communicated. These recipients received late, short or inappropriate posttransplant antibiotic therapy. Transmission did not occur in high-risk recipients who received appropriate and prompt antibiotic therapy for at least 7 days. The safe use of organs from donors with multidrug-resistant bacteria requires intra- and inter-institutional communication to allow appropriate management and prompt treatment of recipients in order to avoid transmission of infection.
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Affiliation(s)
- A Mularoni
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - A Bertani
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - G Vizzini
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - F Gona
- Department of Laboratory Medicine and Advanced Biotechnologies, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - M Campanella
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - M Spada
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - S Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - P Vitulo
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - P Conaldi
- Department of Laboratory Medicine and Advanced Biotechnologies, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - A Luca
- Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - B Gridelli
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - P Grossi
- Department of Infectious and Tropical Diseases, University of Insubria, Varese, Italy
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33
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Andini R, Agrusta F, Mattucci I, Malgeri U, Cavezza G, Utili R, Durante-Mangoni E. Recipient-born bloodstream infection due to extensively drug-resistant Acinetobacter baumannii after emergency heart transplant: report of a case and review of the literature. Infection 2015; 43:609-13. [PMID: 25828937 DOI: 10.1007/s15010-015-0772-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 03/24/2015] [Indexed: 01/28/2023]
Abstract
Infections due to drug-resistant Gram-negative rods are an emerging risk factor for increased mortality after solid organ transplant. Extensively drug-resistant (XDR) Acinetobacter baumannii (Acb) is a major threat in several critical care settings. The limited available data on the outcome of XDR Acb infections in organ transplant recipients mostly comes from cases of donor-derived infections. However, recipients of life-saving organs are often critically ill patients, staying long term in intensive care units, and therefore at high risk for nosocomial infections. In this report, we describe our experience with the exceedingly complex management of a recipient-born XDR Acb bloodstream infection clinically ensued shortly after heart transplant. We also review the current literature on this mounting issue relevant for intensive care, transplant medicine and infectious diseases.
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Affiliation(s)
- Roberto Andini
- Internal Medicine Section, Unit of Infectious and Transplant Medicine, Department of Cardiothoracic Sciences, AORN dei Colli, Ospedale Monaldi, University of Naples S.U.N., Via L. Bianchi 1, 80131, Naples, Italy
| | - Federica Agrusta
- Internal Medicine Section, Unit of Infectious and Transplant Medicine, Department of Cardiothoracic Sciences, AORN dei Colli, Ospedale Monaldi, University of Naples S.U.N., Via L. Bianchi 1, 80131, Naples, Italy
| | - Irene Mattucci
- Internal Medicine Section, Unit of Infectious and Transplant Medicine, Department of Cardiothoracic Sciences, AORN dei Colli, Ospedale Monaldi, University of Naples S.U.N., Via L. Bianchi 1, 80131, Naples, Italy
| | - Umberto Malgeri
- Internal Medicine Section, Unit of Infectious and Transplant Medicine, Department of Cardiothoracic Sciences, AORN dei Colli, Ospedale Monaldi, University of Naples S.U.N., Via L. Bianchi 1, 80131, Naples, Italy
| | - Giusi Cavezza
- Internal Medicine Section, Unit of Infectious and Transplant Medicine, Department of Cardiothoracic Sciences, AORN dei Colli, Ospedale Monaldi, University of Naples S.U.N., Via L. Bianchi 1, 80131, Naples, Italy
| | - Riccardo Utili
- Internal Medicine Section, Unit of Infectious and Transplant Medicine, Department of Cardiothoracic Sciences, AORN dei Colli, Ospedale Monaldi, University of Naples S.U.N., Via L. Bianchi 1, 80131, Naples, Italy
| | - Emanuele Durante-Mangoni
- Internal Medicine Section, Unit of Infectious and Transplant Medicine, Department of Cardiothoracic Sciences, AORN dei Colli, Ospedale Monaldi, University of Naples S.U.N., Via L. Bianchi 1, 80131, Naples, Italy.
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34
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Acinetobacter baumannii and cardiac impairment. Increasingly important nosocomial pathogen. Int J Cardiol 2015; 197:164-5. [PMID: 26142199 DOI: 10.1016/j.ijcard.2015.06.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 06/20/2015] [Indexed: 11/23/2022]
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35
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Lee HY, Lee HY, Shin SB, Shin KS, Lee BW, Kim HW, Lee S, Kim SC. Lung Transplantation in a Patient with Pre-transplant Colonization of Extensively Drug-resistant Acinetobacter baumannii. Korean J Crit Care Med 2015. [DOI: 10.4266/kjccm.2015.30.2.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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36
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Laganà P, Melcarne L, Delia S. Acinetobacter baumannii and endocarditis, rare complication but important clinical relevance. Int J Cardiol 2015; 187:678-9. [DOI: 10.1016/j.ijcard.2015.04.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 04/02/2015] [Indexed: 11/24/2022]
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37
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Gao F, Ye Q, Wan Q, Liu S, Zhou J. Distribution and resistance of pathogens in liver transplant recipients with Acinetobacter baumannii infection. Ther Clin Risk Manag 2015. [PMID: 25848296 DOI: 10.2147/tcrm.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Drug-resistant Acinetobacter baumannii has become a major problem in liver transplant recipients. The aim of this study was to investigate the clinical presentation, distribution, and drug susceptibility characteristics in liver recipients with A. baumannii infection. METHODS We retrospectively investigated 17 liver recipients who developed A. baumannii infection between January 1, 2007 and December 31, 2014. The distribution of A. baumannii and drug susceptibility characteristics were reviewed. RESULTS Infectious complications due to A. baumannii appeared in 17 liver recipients, with a total of 24 episodes. Approximately 63% (15/24) of A. baumannii infections occurred within 2 weeks after transplantation. The most common source of infection was multiple culture-positive sites (35.3%, n=6), followed by the intra-abdominal/biliary tract (23.5%, n=4) and lung (23.5%, n=4). Eight patients (47.1%) had a body temperature of 38°C or higher at the onset of A. baumannii infection. Nine, seven, and 12 recipients had a serum creatinine level of >1.5 mg/dL, a white blood cell count of >15,000/mm(3), and a platelet count of <50,000/mm(3), respectively. There were five (29.4%) cases of septic shock and eight (47.1%) deaths. The rate of antibiotic resistance of A. baumannii to ten of 12 antibiotics investigated was more than 60%. Among the 24 infections caused by A. baumannii, 75% were carbapenem-resistant. The rods were relatively sensitive to tigecycline and cefoperazone-sulbactam. CONCLUSION The clinical manifestations of A. baumannii infection included a high body temperature, a decreased platelet count, an elevated white blood cell count, and onset in the early period after transplantation as well as high mortality. The antibiotic resistance rate of A. baumannii was extremely high. Prevention measures and combination antibiotic therapy are needed to improve the outcomes of liver recipients with A. baumannii infections.
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Affiliation(s)
- Fei Gao
- Infectious Disease Department of Henan Province People's Hospital, Zhengzhou, People's Republic of China
| | - Qifa Ye
- Department of Transplant Surgery, Third Xiangya Hospital, Central South University, Changsha, People's Republic of China ; Department of Transplant Surgery, Zhongnan Hospital, Wuhan University, Wuhan, People's Republic of China
| | - Qiquan Wan
- Department of Transplant Surgery, Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Shan Liu
- Adelphi University College of Nursing and Public Health, New York, NY, USA
| | - Jiandang Zhou
- Department of Clinical Laboratory of Microbiology, Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
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Gao F, Ye Q, Wan Q, Liu S, Zhou J. Distribution and resistance of pathogens in liver transplant recipients with Acinetobacter baumannii infection. Ther Clin Risk Manag 2015; 11:501-505. [PMID: 25848296 PMCID: PMC4381901 DOI: 10.2147/tcrm.s82251] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Drug-resistant Acinetobacter baumannii has become a major problem in liver transplant recipients. The aim of this study was to investigate the clinical presentation, distribution, and drug susceptibility characteristics in liver recipients with A. baumannii infection. METHODS We retrospectively investigated 17 liver recipients who developed A. baumannii infection between January 1, 2007 and December 31, 2014. The distribution of A. baumannii and drug susceptibility characteristics were reviewed. RESULTS Infectious complications due to A. baumannii appeared in 17 liver recipients, with a total of 24 episodes. Approximately 63% (15/24) of A. baumannii infections occurred within 2 weeks after transplantation. The most common source of infection was multiple culture-positive sites (35.3%, n=6), followed by the intra-abdominal/biliary tract (23.5%, n=4) and lung (23.5%, n=4). Eight patients (47.1%) had a body temperature of 38°C or higher at the onset of A. baumannii infection. Nine, seven, and 12 recipients had a serum creatinine level of >1.5 mg/dL, a white blood cell count of >15,000/mm(3), and a platelet count of <50,000/mm(3), respectively. There were five (29.4%) cases of septic shock and eight (47.1%) deaths. The rate of antibiotic resistance of A. baumannii to ten of 12 antibiotics investigated was more than 60%. Among the 24 infections caused by A. baumannii, 75% were carbapenem-resistant. The rods were relatively sensitive to tigecycline and cefoperazone-sulbactam. CONCLUSION The clinical manifestations of A. baumannii infection included a high body temperature, a decreased platelet count, an elevated white blood cell count, and onset in the early period after transplantation as well as high mortality. The antibiotic resistance rate of A. baumannii was extremely high. Prevention measures and combination antibiotic therapy are needed to improve the outcomes of liver recipients with A. baumannii infections.
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Affiliation(s)
- Fei Gao
- Infectious Disease Department of Henan Province People’s Hospital, Zhengzhou, People’s Republic of China
| | - Qifa Ye
- Department of Transplant Surgery, Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Department of Transplant Surgery, Zhongnan Hospital, Wuhan University, Wuhan, People’s Republic of China
| | - Qiquan Wan
- Department of Transplant Surgery, Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Shan Liu
- Adelphi University College of Nursing and Public Health, New York, NY, USA
| | - Jiandang Zhou
- Department of Clinical Laboratory of Microbiology, Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
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Patel G, Perez F, Hujer AM, Rudin SD, Augustine JJ, Jacobs GH, Jacobs MR, Bonomo RA. Fulminant endocarditis and disseminated infection caused by carbapenem-resistant Acinetobacter baumannii in a renal-pancreas transplant recipient. Transpl Infect Dis 2015; 17:289-96. [PMID: 25661804 DOI: 10.1111/tid.12351] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/13/2014] [Accepted: 12/11/2014] [Indexed: 01/23/2023]
Abstract
Acinetobacter baumannii is an important cause of healthcare-associated infections, and is particularly problematic among patients who undergo organ transplantation. We describe a case of fulminant sepsis caused by carbapenem-resistant A. baumannii harboring the blaOXA-23 carbapenemase gene and belonging to international clone II. This isolate led to the death of a patient 6 days after simultaneous kidney-pancreas transplantation. Autopsy findings revealed acute mitral valve endocarditis, myocarditis, splenic and renal emboli, peritonitis, and pneumonia. This case highlights the severe nature of certain A. baumannii infections and the vulnerability of transplanted patients to the increasingly intractable "high-risk" clones of multidrug-resistant organisms.
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Affiliation(s)
- G Patel
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Solomennyi A, Goncharov A, Zueva L. Extensively drug-resistant Acinetobacter baumannii belonging to the international clonal lineage I in a Russian burn intensive care unit. Int J Antimicrob Agents 2014; 45:525-8. [PMID: 25604276 DOI: 10.1016/j.ijantimicag.2014.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 10/20/2014] [Accepted: 10/20/2014] [Indexed: 10/24/2022]
Abstract
The high incidence of mortality in patients with severe burns can be attributed to bloodstream infections caused by drug-resistant microorganisms. Multilocus variable-number tandem repeat analysis (MLVA), multilocus sequence typing (MLST) and class 1 integron PCR amplification were performed to investigate an extensively drug-resistant Acinetobacter baumannii (XDR-AB) strain recovered from a blood culture of a patient admitted to a burn intensive care unit in St Petersburg (Russian Federation). This case study describes an XDR-AB strain of multilocus sequence type ST231 with a blaGES-12 gene cassette encoding a very potent ceftazidimase located inside of a composite class 1 integron. This is the first documented case of XDR-AB belonging to the international clonal lineage I in Russia.
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Affiliation(s)
- Aleksandr Solomennyi
- Institute of Ecology and Genetics of Microorganisms, Ural Branch of the Russian Academy of Sciences, Perm, Russian Federation.
| | - Artemiy Goncharov
- I.I. Mechnikov North-Western State Medical University, St Petersburg, Russian Federation
| | - Lyudmila Zueva
- I.I. Mechnikov North-Western State Medical University, St Petersburg, Russian Federation
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Abstract
Unusual clinical syndromes or clusters of infections in recipients of organs from the same donor suggest donor-derived infection as a possible source of transmission The incidence of transmission of unexpected infection by organ allografts is low, but precise data are lacking Screening of donors for common pathogens involves both epidemiologic history and microbiological assays, and is highly effective for preventing the transmission of HIV and hepatitis B and C viruses Donor screening for uncommon pathogens must be guided by knowledge of changes in the local epidemiology of infection The key element in the detection of donor-derived infection is suspicion on the part of the clinicians caring for organ recipients Application of newer microbiological techniques will increase the speed of donor screening and enhance transplant safety Each year, over 70,000 organs are transplanted worldwide. The degree of risk of transmission of infection from transplanted organs to the recipient is largely unknown and is difficult to assess for specific organs. Here, Jay A. Fishman and Paolo A. Grossi describe the major risk factors for organ donor-derived transmission of infection and discuss opportunities to reduce the incidence of such events. Organ transplantation, including of the heart, lung, kidney, liver, pancreas, and small bowel, is considered the therapy of choice for end-stage organ failure. Each year, over 70,000 organs are implanted worldwide. One donor may provide multiple organs, as well as corneas and other tissues, for multiple recipients. The degree of risk for transmission of infection carried with grafts, notably of viruses, is largely unknown and, for a specific organ, difficult to assess. The approach to microbiological screening of organ donors varies with national and regional regulations and with the availability and performance of microbiological assays used for potential donors. Transmission of both expected or common, and unexpected infections has been observed in organ transplants, generally recognized after development of clusters of infections among recipients of organs from a common donor. Other than for unusual or catastrophic events, few data exist that define the incidence and manifestations of donor-derived infections or the ideal assays to use in screening to prevent such transmissions. Absolute prevention of the transmission of donor-derived infections in organ transplantation is not possible. However, improvements in screening technologies will enhance the safety of transplantation in the future.
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Affiliation(s)
- Jay A Fishman
- Transplant Infectious Disease Program, Infectious Disease Division and MGH Transplantation Center, 55 Fruit Street, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114-2696, USA
| | - Paolo A Grossi
- National Centre for Transplantation, Infectious and Tropical Diseases Department, University of Insubria, Varese 21100, Italy
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Jr CSK, Koval CE, Duin DV, Morais AGD, Gonzalez BE, Avery RK, Mawhorter SD, Brizendine KD, Cober ED, Miranda C, Shrestha RK, Teixeira L, Mossad SB. Selecting suitable solid organ transplant donors: Reducing the risk of donor-transmitted infections. World J Transplant 2014; 4:43-56. [PMID: 25032095 PMCID: PMC4094952 DOI: 10.5500/wjt.v4.i2.43] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/21/2014] [Accepted: 05/14/2014] [Indexed: 02/05/2023] Open
Abstract
Selection of the appropriate donor is essential to a successful allograft recipient outcome for solid organ transplantation. Multiple infectious diseases have been transmitted from the donor to the recipient via transplantation. Donor-transmitted infections cause increased morbidity and mortality to the recipient. In recent years, a series of high-profile transmissions of infections have occurred in organ recipients prompting increased attention on the process of improving the selection of an appropriate donor that balances the shortage of needed allografts with an approach that mitigates the risk of donor-transmitted infection to the recipient. Important advances focused on improving donor screening diagnostics, using previously excluded high-risk donors, and individualizing the selection of allografts to recipients based on their prior infection history are serving to increase the donor pool and improve outcomes after transplant. This article serves to review the relevant literature surrounding this topic and to provide a suggested approach to the selection of an appropriate solid organ transplant donor.
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Santoro-Lopes G, Gouvêa EFD. Multidrug-resistant bacterial infections after liver transplantation: An ever-growing challenge. World J Gastroenterol 2014; 20:6201-6210. [PMID: 24876740 PMCID: PMC4033457 DOI: 10.3748/wjg.v20.i20.6201] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/20/2014] [Accepted: 03/13/2014] [Indexed: 02/06/2023] Open
Abstract
Bacterial infections are a leading cause of morbidity and mortality among solid organ transplant recipients. Over the last two decades, various multidrug-resistant (MDR) pathogens have emerged as relevant causes of infection in this population. Although this fact reflects the spread of MDR pathogens in health care facilities worldwide, several factors relating to the care of transplant donor candidates and recipients render these patients particularly prone to the acquisition of MDR bacteria and increase the likelihood of MDR infectious outbreaks in transplant units. The awareness of this high vulnerability of transplant recipients to infection leads to the more frequent use of broad-spectrum empiric antibiotic therapy, which further contributes to the selection of drug resistance. This vicious cycle is difficult to avoid and leads to a scenario of increased complexity and narrowed therapeutic options. Infection by MDR pathogens is more frequently associated with a failure to start appropriate empiric antimicrobial therapy. The lack of appropriate treatment may contribute to the high mortality occurring in transplant recipients with MDR infections. Furthermore, high therapeutic failure rates have been observed in patients infected with extensively-resistant pathogens, such as carbapenem-resistant Enterobacteriaceae, for which optimal treatment remains undefined. In such a context, the careful implementation of preventive strategies is of utmost importance to minimize the negative impact that MDR infections may have on the outcome of liver transplant recipients. This article reviews the current literature regarding the incidence and outcome of MDR infections in liver transplant recipients, and summarizes current preventive and therapeutic recommendations.
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Clímaco EC, Oliveira MLD, Pitondo-Silva A, Oliveira MG, Medeiros M, Lincopan N, da Costa Darini AL. Clonal complexes 104, 109 and 113 playing a major role in the dissemination of OXA-carbapenemase-producing Acinetobacter baumannii in Southeast Brazil. INFECTION GENETICS AND EVOLUTION 2013; 19:127-33. [PMID: 23838284 DOI: 10.1016/j.meegid.2013.06.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 06/15/2013] [Accepted: 06/22/2013] [Indexed: 10/26/2022]
Abstract
Carbapenem resistance among Acinetobacter baumannii strains isolated from clinical settings in Brazil has increased dramatically in the last 10 years due to the emergence and dissemination of OXA-type carbapenemase encoding genes. This study aimed to characterize the presence of carbapenem-hydrolyzing class D β-lactamases (CHDL)-encoding genes and clonal complexes playing a major role in the dissemination of OXA-carbapenemase-producing A. baumannii in Southeast Brazil. A total of 74 A. baumannii strains isolated from patients admitted to 4 hospitals in Southeast Brazil were analyzed. Molecular characterization of strains revealed that 67 strains carried blaOXA-23 (72%), blaOXA-143 (25%) or both genes (3%). PFGE analysis identified 12 PFGE clusters, grouping 26 pulsotypes. Two PFGE clusters were predominant, comprising more than 66% of OXA-producing A. baumannii isolates. Among 23 representative strains characterized by MLST-UO (Multilocus Sequence Typing Scheme - University of Oxford, http://pubmlst.org/abaumannii/), 14 different STs were identified, of which six were confirmed as novel sequence types (designated as STs 402-407). Most of these isolates belonged to clonal complexes CC104,CC109 or CC113, whereas three STs were singletons (ST339, 403 and 407). In conclusion, the presence of blaOXA-23- and blaOXA-143-like genes was not related to specific ST/CC, suggesting that the dissemination of OXA-carbapenemase-encoding genes may involve different STs, in which the spread of OXA-23-like is most likely due to mobile elements (i.e., plasmids). In this regard, CC104, CC109 and CC113 played a major role as predominant CDHL-carrying clones, instead of CC92, which was not identified.
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Affiliation(s)
- Eduardo Carneiro Clímaco
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Brazil
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45
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Doucette KE, Al-Saif M, Kneteman N, Chui L, Tyrrell GJ, Kumar D, Humar A. Donor-derived bacteremia in liver transplant recipients despite antibiotic prophylaxis. Am J Transplant 2013; 13:1080-1083. [PMID: 23398841 DOI: 10.1111/ajt.12133] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 12/03/2012] [Accepted: 12/07/2012] [Indexed: 02/06/2023]
Abstract
As the disparity between the number of candidates listed for transplant and the number of donors continues to grow, marginal organ donors are increasingly utilized. This includes bacteremic donors which may carry an increased risk of transmission of infection. It is recommended that recipients of organs from bacteremic donors receive antibiotic prophylaxis based on the susceptibilities of the donor isolate to prevent transmission. Here, we present four cases of donor-derived bacteremia, despite appropriate antimicrobial prophylaxis, in four liver transplant recipients. Transmitted pathogens included Staphylococcus aureus in two cases, and Escherichia coli and Group B Streptococcus each in one case. Interestingly, none of the nonhepatic organs (n=10) utilized from these bacteremic donors resulted in transmissions. These cases highlight the fact that risk of transmission from bacteremic donors is not eliminated with antimicrobial therapy in the donor and recipient. As no transmissions occurred in recipients of nonhepatic organs from these donors, these cases also suggest that liver recipients may be at higher risk of donor transmitted bacteremia.
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Affiliation(s)
- K E Doucette
- Transplant Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - M Al-Saif
- Transplant Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - N Kneteman
- Division of Transplantation, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - L Chui
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.,Provincial Laboratory for Public Health, Alberta Health Services, Edmonton, Alberta, Canada
| | - G J Tyrrell
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.,Provincial Laboratory for Public Health, Alberta Health Services, Edmonton, Alberta, Canada
| | - D Kumar
- Transplant Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - A Humar
- Transplant Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Ison MG, Grossi P. Donor-derived infections in solid organ transplantation. Am J Transplant 2013; 13 Suppl 4:22-30. [PMID: 23464995 DOI: 10.1111/ajt.12095] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- M G Ison
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Northwestern University Comprehensive Transplant Center, Chicago, IL, USA.
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47
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Martins N, Martins IS, de Freitas WV, de Matos JA, Girão VBDC, Coelho-Souza T, Maralhães ACDG, Cacci LC, de Figueiredo MP, Dias RCS, Costa-Lourenço APR, Ferreira ALP, Dalla-Costa L, Nouér SA, Santoro-Lopes G, Riley LW, Moreira BM. Imported and intensive care unit-born Acinetobacter baumannii clonal complexes: one-year prospective cohort study in intensive care patients. Microb Drug Resist 2013; 19:216-23. [PMID: 23336529 DOI: 10.1089/mdr.2012.0174] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The main objective of this study was to assess the frequency and possible sources of colonization and infection by Acinetobacter in the intensive care unit (ICU) of a university hospital in Rio de Janeiro, Brazil, and characterize the isolates for relatedness to internationally and locally disseminated lineages. Patients consecutively admitted to the ICU from April 2007 to April 2008 were screened for colonization and infection. Species were identified by rpoB sequencing. The presence of acquired and intrinsic carbapenemase genes was assessed by polymerase chain reaction (PCR). Strains were typed by random amplification of polymorphic DNA (RAPD)-PCR, pulsed-field gel electrophoresis, and multilocus sequence typing (MLST) using the schemes hosted at the University of Oxford (UO) and Institut Pasteur (IP). Of 234 patients, 98 (42%) had at least one specimen positive for the Acinetobacter isolate, and 24 (10%) had infection. A total of 22 (92%) infections were caused by Acinetobacter baumannii and one each (4%) by Acinetobacter nosocomialis and Acinetobacter berezinae. A. baumannii isolates from 60 patients belonged to RAPD types that corresponded to MLST clonal complexes (CCs) 109/1 (UO/IP scheme, known as International Clone I), CC 110/110 (UO/IP), CC 113/79 (UO/IP), and CC 104/15 (UO/IP). Most CCs were carbapenem resistant and carried the bla(OXA-23)-like gene. Strains were introduced by patients transferred from other wards of the same hospital (11 patients, 18%) or acquired from cross-transmission within the ICU (49 patients, 82%). A. nosocomialis lineage sequence type 260 colonized 10% of the whole study population. A. baumannii have become established in this hospital as a part of a global epidemic of successful clones. Once introduced into the hospital, such clones have become entrenched among patients in the ICU.
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Affiliation(s)
- Natacha Martins
- Institute of Microbiology, Federal University of Rio de Janeiro, Brazil
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Abstract
Over the past decade, the solid organ transplant community has focused increased attention on unexpected transmission of infectious pathogens from organ donor to recipient. While unexpected donor-derived infections are relatively uncommon, recent cases of transmission of human immunodeficiency virus (HIV) and hepatitis C to multiple recipients, as well as transmission of HIV from a living donor, have further increased interest in improving the safety of solid organ transplantation. This article will review the epidemiology and outcomes associated with unexpected donor-derived infection. Furthermore, the reporting and patient safety process will be discussed, as will preventative measures that can reduce the burden of donor-derived infection.
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49
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Sifri CD, Ison MG. Highly resistant bacteria and donor-derived infections: treading in uncharted territory. Transpl Infect Dis 2012; 14:223-8. [PMID: 22676635 DOI: 10.1111/j.1399-3062.2012.00752.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Karah N, Sundsfjord A, Towner K, Samuelsen Ø. Insights into the global molecular epidemiology of carbapenem non-susceptible clones of Acinetobacter baumannii. Drug Resist Updat 2012; 15:237-47. [PMID: 22841809 DOI: 10.1016/j.drup.2012.06.001] [Citation(s) in RCA: 198] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 06/29/2012] [Indexed: 12/17/2022]
Abstract
The global emergence of multidrug resistance (MDR) among Gram-negative bacteria has dramatically limited the therapeutic options. During the last two decades, Acinetobacter baumannii has become a pathogen of increased clinical importance due to its remarkable ability to cause outbreaks of infections and to acquire resistance to almost all currently used antibiotics, including the carbapenems. This review considers the literature on A. baumannii and data from multilocus sequence typing studies to explore the global population structure of A. baumannii and detect the occurrence of clonality, with the focus on the presence of specific resistance mechanisms such as the OXA-carbapenemases. The worldwide dissemination of MDR and carbapenem non-susceptible A. baumannii is associated with diverse genetic backgrounds, but predominated by a number of extensively distributed clones, such as CC92(B)/CC2(P) and CC109(B)/CC1(P), which have frequently been supplemented by acquired OXA-type carbapenemase genes.
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Affiliation(s)
- Nabil Karah
- Reference Centre for Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
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