Transplant Infectious Disease最新文献

Background: Although infections are a leading cause of morbidity and mortality among patients with multiple myeloma (MM), the epidemiology of invasive fungal disease (IFD) is less well characterized in this population than in other hematologic malignancies.

Methods: We conducted a nested 3:1 case-control study of IFD at a large MM referral center to identify risk factors for IFD in this population.

Results: In a cohort of 2960 patients, we identified 32 episodes of IFD among 31 patients between 01/2011 and 06/2019. There was a median of 3.6 years from MM diagnosis to IFD, and patients had a median of four lines of chemotherapy (range 1-12) before IFD. Seventeen (53%) had previous autologous hematopoietic cell transplants. At the time of IFD, 23 (72%) had progressive disease status. Fifteen (47%) and 13 (41%) had severe neutropenia and lymphopenia, respectively, and 18 (56%) had hypogammaglobulinemia. Microbiologic etiologies included Aspergillus (n = 18), Candida (n = 6), Cryptococcus (n = 3), Mucorales (n = 3), Histoplasma (n = 1), and undetermined organism (n = 1). In the case-control analysis, progressive disease status (OR 1.35, p = 0.02) and neutropenia (OR 17.5, p = 0.02) were significant risk factors for IFD. In addition, ≥3 prior lines of chemotherapy trended toward statistical significance (OR 5.6, p = 0.07).

Conclusion: This is the largest detailed description of IFD epidemiology in MM patients and the largest controlled analysis of risk factors in this population. Overall, the risk of IFD was low.

Introduction: Carbapenemase-producing Enterobacterales (CPE) are associated with increased morbidity and mortality in liver transplant recipients (LTRs). There is a paucity of data regarding CPE colonization and infection in Australian LTRs.

Methods: A single-center retrospective cohort study of CPE was performed in LTRs from 2015 to 2024. LTRs underwent targeted screening and a period of enhanced screening to evaluate the incidence of CPE colonization. CPE infections were identified via clinical samples. All CPE isolates underwent whole genome sequencing. CPE isolation rates in LTRs were compared to the general hospital population and trends over time were analyzed.

Results: There were 31 episodes of CPE isolation (5 community acquired, 26 healthcare associated) from 28 LTRs. Nine episodes of CPE infection were found: urinary tract (n = 3), bloodstream (n = 3), wound/abscess (n = 2), and Salmonella gastroenteritis (n = 1). The remaining 22 episodes represented new CPE colonization. CPE Klebsiella pneumoniae was the most common bacterial species (n = 12) with the New Delhi metallo-β-lactamase (n = 13), the most common CPE gene detected. CPE isolation rates in LTRs increased over the study period (p = 0.06). The overall rate of CPE infection was significantly higher in LTRs than the general hospital population (1.92 vs. 0.30 per 10 000 occupied bed days, p = 0.04). Enhanced CPE screening identified an additional eight episodes of CPE colonization in 415 patients screened (1.9%).

Conclusion: CPE is an emerging threat for Australian LTRs and there is an urgent need to optimize strategies to prevent CPE colonization and infection in LTRs.

Background: Refractory and/or resistant (R/R) cytomegalovirus (CMV) infection is a serious complication after allogeneic hematopoietic cell transplantation (HCT). Maribavir, an oral antiviral agent, was approved in November 2021 for the treatment of R/R CMV in transplant recipients. However, real-world data on the use of maribavir in HCT recipients and hematologic malignancy (HM) patients are limited. We described our early experience with the use of maribavir in the year after its Food and Drug Administration approval in HCT recipients and HM patients.

Methods: We performed a retrospective study of all patients who received maribavir for treatment of CMV infection at our center from November 2021 to December 2022. Clinical characteristics and outcomes of CMV infection were collected for each case. Descriptive statistics were calculated.

Results: Our study included 13 patients (11 of whom were HCT recipients and two with HM) who received a median of 58 days of maribavir therapy. While on maribavir, nine (69%) patients had a resolution of CMV infection. Treatment-emergent maribavir resistance was documented in one patient with a CMV UL97 C480F mutation. Patients with higher baseline viral loads were less likely to achieve CMV resolution compared to those with lower levels. Additionally, six patients received combination therapy with maribavir. Six patients developed dysgeusia, none requiring maribavir discontinuation.

Conclusion: Maribavir is an effective and safe option for the treatment of R/R CMV infections in HCT recipients and HM patients. Our study highlights the complexities of managing CMV infections in this patient population and some challenges associated with maribavir therapy.

Background: The role of fiberoptic bronchoscopy (FOB) in the management of patients presenting with pulmonary infiltrates after hematopoietic stem cell transplant (HSCT) remains unclear. We aimed to evaluate the diagnostic value and safety of FOB at our center.

Methods: This retrospective study included all patients with post-HSCT pulmonary infiltrates who underwent FOB between 2016 and 2019. The demographic, clinical, interventional, microbiological, and histological data and changes in management and the 6-month outcome were recorded.

Results: A total of 86 consecutive HSCT recipients were included. The median patient age was 34 years (range: 14-67), 53 patients (61.6%) were males. The median interval between symptom onset and FOB was 7 days (IQR: 2-17). FOB yielded a positive result in 53 patients (61.6%). The pathogen was a virus, bacteria, fungus in 29 (33.7%), 19 (22.1%), and 11 (12.8%) patients, respectively. The treatment was modified in 52 patients (60.5%) according to the FOB result. An imaging finding of "tree-in-bud" was associated with a positive FOB yield (p = 0.05). The timing of bronchoscopy (<4 vs. ≥5 days), graft-versus-host disease, neutropenia, and antimicrobial use had no significant effect (p > 0.05). No serious complications were encountered.

Conclusion: FOB led to changes in management in over half of the patients. Delay up to 1 week after presentation and empirical antimicrobials did not have any effect on the yield. FOB is a safe diagnostic tool in the post-HSCT patients with pulmonary infiltrates.

Introduction: Infections significantly impact morbidity and mortality in lung transplant (LuTx) recipients. This survey focused on documenting current practices regarding the prevention and management of infections in LuTx in Italy.

Methods: A 52-question survey was administered online in the period from December 1, 2023, to January 31, 2024, assessing center characteristics, Tx team organization, microbiological investigations, infection prevention, and management. All Italian LuTx centers were invited to participate.

Results: Nine out of 10 Italian LuTx centers answered. Most centers (6/9, 67%) performed LuTx only on adults. Chronic infection or colonization by Mycobacterium abscessus and Burkholderia cenocepacia is considered a contraindication to LuTx in five and two centers, respectively. For cytomegalovirus D+/R- patients, prophylaxis is used in six centers (67%), with a variable duration from 3 to 12 months. Two centers also use IgG. Three centers (33%) use a pre-emptive strategy. Four centers (45%) screen for Human herpesvirus 8 infection. Regarding antibiotic prophylaxis, most centers (6/9, 67%) utilise a dual regimen of anti-pseudomonal penicillin plus glycopeptide. The two most common durations of antibiotic prophylaxis were 72 h and 7 days, each reported by two centers (22%). Targeted prophylaxis against fungal infections is employed by a minority of centers (4/9, 44%). Inhaled amphotericin B is the most common antifungal, used as targeted prophylaxis (2/4, 50%) and universal prophylaxis (2/5, 40%). Almost all centers (8/9, 89%) involve the Tx infectious diseases specialist in the recipient management since the pre-listing period.

Conclusion: There is considerable heterogeneity in infection management among Italian LuTx centers. Establishing a shared platform for data collection and outcome evaluation is essential to improve infection management.

Background: Cytomegalovirus (CMV) infection remains among the leading complications after solid organ transplantation (SOT). Large international surveys mainly focused on high-income countries, detected considerable variability in the management of this infection after SOT. Limited data are available from resource-limited settings.

Methods: A questionnaire-based cross-sectional study was performed. All transplant programs (TP) registered at the Brazilian Organ Transplantation Society (ABTO) were invited to participate.

Results: Sixty-one TP participated in the study. Of these, 59 (97%) reported using at least 1 preventive strategy (prophylaxis or preemptive therapy [PET]). Prophylaxis was reported by only 39 (64%). PET was used by 52 (85%), predominantly for R+ recipients (n = 42/61; 70%). CMV monitoring was performed weekly in only 22 of 52 (42%) TP. This was significantly more common in TP reporting turnaround times ≤72 h for quantitative nuclear acid amplification tests (p < 0.001). Intravenous (IV) ganciclovir was the predominant drug chosen for prophylaxis (21/39 TP; 54%) and for PET (44/52 TP; 77%). Lack of regular access to valganciclovir was significantly associated with the choice of IV ganciclovir for prophylaxis and PET (p = 0.002 for both comparisons). Only 8 (13%) TP had access to molecular diagnostic tests for ganciclovir resistance, and 14 (23%) had access to effective therapy for highly resistant infections.

Conclusion: These results suggest that strategies to improve the management of CMV after SOT in such a resource-limited setting are needed and should include not only targeted educational programs but also initiatives to tackle economic and structural barriers.