Transplant Infectious Disease最新文献

Background: Infection is a significant cause of morbidity and mortality among solid-organ transplant (SOT) recipients. Australasia currently has no standardized system for the surveillance of infection across organ-transplant groups nor SOT-specific infection prevention and control (IPC) guidelines. This sub-cohort analysis of the INTERACT study sought to understand existing IPC and infection monitoring practices in Australasian centers providing transplant care to guide consensus recommendations.

Methods: A cross-sectional survey was administered to infectious disease (ID), microbiology, and IPC specialists involved in the care of the high-risk immunocompromised host within Australasian healthcare facilities (HCFs).

Results: A total of 97 healthcare workers caring for SOT patients responded, predominantly employed by public HCFs. A total of 76.3% were practicing in transplant centers (primarily renal), with responses gained from all Australasian transplant jurisdictions. Although on-site IPC programs were customary (present in 96.9%), few had dedicated transplant-ID services (38.1%). Surveillance for healthcare-associated infections was reported by the majority (75.3%), with monitoring for opportunistic infections less frequent (23.7%). While 50.5% reported a staff mask-wearing mandate, and 22.7% a gown/glove policy on transplant wards, the timing of routine personal protective use post-transplantation was heterogeneous. Screening practices for multidrug-resistant organisms varied, with routine approaches more prevalent within facilities performing transplant surgery (38.1%-100.0% vs. 39.1%-46.4%). Just over half (58.8%) of respondents provided counselling to SOT recipients for safe-living post-discharge.

Conclusion: This is the first analysis of IPC/surveillance practice in the care of the Australasian SOT population, revealing practice variability and emphasizing the need for standardization to optimize transplant outcomes and reduce infection risk.

Background: Infections are a common complication among lung transplant recipients (LuTR), particularly in the first year post-transplant, with respiratory tract infections (RTI) being predominant. Syndromic molecular panels have been suggested to reduce morbidity and mortality by providing a diagnosis quickly. However, integrating these panels into clinical practice remains debated.

Methods: An electronic search was conducted in PubMed, Scopus, and Embase to identify studies on applying syndromic panels for RTI diagnosis in LuTR. Three reviewers independently screened-extracted data from relevant studies, focusing on concordance between syndromic panels and standard microbiologic tests and reporting isolates not detected by syndromic panels.

Results: Four studies met the inclusion criteria, including 308 patients. The BioFire FilmArray Pneumonia Panel was the syndromic panel most frequently employed. In three studies, the syndromic panel was employed in LuTR with suspected RTI or during routine surveillance bronchoalveolar lavage; only in one case was the syndromic panel employed during the transplant procedure on samples from the donor. Agreement between syndromic panels and standard tests ranged from 0.56 to 0.98, with result turnaround times between 2.3 and 21.2 h. Sensitivity ranged from 58% to 94%, and specificity from 78% to 100%. Pathogens outside syndromic panels targets but identified by standard tests included Candida spp., unspecified gram-negative rods, and Aspergillus spp.

Conclusion: Syndromic panels offer a faster alternative to standard microbiologic tests. However, they miss numerous possible pathogens, highlighting the necessity for concurrent standard testing. Further research is needed to establish the most efficient integration of syndromic panels in LuTx infection diagnostic.

Background: Treating Mycobacterium avium complex (MAC) infection pre-lung transplant (LT) can be challenging to treat, given prolonged therapy and side effects. The impact of pre-transplant MAC treatment on recurrence and outcomes post-LT remains unclear, especially in patients with interstitial lung disease (ILD) who have a median survival of less than 2 years.

Methods: We performed a retrospective cohort study of adult LT patients at the Mayo Clinic who had positive MAC sputum cultures pre-LT. The cohort was stratified and compared based on the type of treatment (complete, partial, or no treatment) for MAC pulmonary infection. The primary outcome was MAC recurrence post-LT, and secondary outcomes were mortality, FEV-1, and FVC at 1-year post-LT.

Results: Among the cohort of 47 patients, 9 (19.1%) were partially treated and 11 (23.4%) were completely treated for MAC infection pre-LT. Post-transplant MAC pulmonary infection recurrence occurred in eight (17%) of the total cohort, with four (14.8%) in the non-treated, four (44.4%) in the partially-treated, and none (0%) in the completely treated patients (p = 0.026). There was no difference in mortality in patients who had MAC recurrence post-transplantation (13% vs. 9.7%, p > 0.9) and those who were completely or partially treated, compared to non-treated (0% vs. 13% vs. 13%, p > 0.9). The FEV1 and FVC at 1-year post-LT did not differ by the pre-transplant treatment or post-transplant MAC recurrence status.

Conclusion: The role of treatment for MAC infection pre-transplant is questionable, especially in patients with diseases like ILD who may not have enough wait time to complete therapy.

Background: Vancomycin plus an antipseudomonal β-lactam are common antibiotics used for lung transplant surgical prophylaxis, but the optimal post-operative duration is unknown. The study objective was to assess the impact of a shortened antibacterial surgical prophylaxis duration on post-operative acute kidney injury (AKI) in lung transplant recipients.

Methods: This was an IRB approved, single pre-/post-test quasi-experiment of lung transplant recipients who received post-operative antibiotic prophylaxis from January 1, 2016-September 30, 2020 (pre-group) to October 1, 2020-March 31, 2025 (post-group). The intervention included modifying vancomycin (and cefepime) post-operative prophylaxis durations to 72 h; the previous prophylaxis standard included continuing vancomycin until chest tube removal. The primary endpoint was incidence of AKI, defined by the KDIGO criteria, while receiving post-operative vancomycin up to 14 days. Thirty-day secondary outcomes included surgical site infection (SSI), treatment of lower respiratory-tract infection, and isolation of multi-drug-resistant organisms (MDRO).

Results: Ninety patients were included-45 pre- and 45 post-intervention. Most patients were men (64.4%) and had a median (IQR) age of 63 (58-68) years. The most common indication for transplant was pulmonary fibrosis (37.8%). The incidence of 14-day AKI was reduced when comparing pre- and post-intervention groups (48.9% vs. 28.9%, p = 0.052), with no differences in SSI (2.2% vs. 2.2%, p = 1.0), treatment of lower respiratory tract infection (57.8% vs. 73.3%, p = 0.120), and isolation of MDRO (15.6% vs. 13.3%, p = 0.764). When accounting for baseline renal function, patients in the post-intervention group had a significantly decreased odds of AKI (adjOR, 0.385; 95%CI, 0.154-0.959).

Conclusion: Implementation of a shortened post-operative vancomycin prophylaxis duration protocol was associated with reduced odds of AKI in lung transplant recipients, with similar post-operative infectious complications.

Infection with Dengue virus (DENV)is a growing concern in solid organ transplant (SOT) recipients in endemic regions. We report a 15-year-old kidney transplant recipient who developed fever and thrombocytopenia on post-transplant day five; DENV NS1 antigen confirmed acute infection. He recovered with supportive care, and no donor-derived transmission was identified. A review of 327 cases shows early post-transplant dengue carries higher risks of cytopenias, capillary leak, graft dysfunction, and mortality (6.1%) versus the general population. Improved diagnostics, outbreak-responsive donor screening, and pre-transplant vaccination in immunocompetent candidates may help mitigate dengue burden in SOT recipients.

Background: Solid organ transplant (SOT) recipients are vulnerable to infections with multidrug-resistant organisms, and they often do not receive adequate empiric antimicrobials for serious Gram-negative infections. Knowledge of differences in antimicrobial resistance rates in this specific population can help guide empiric antimicrobial choices.

Methods: We performed a retrospective cohort study comparing antimicrobial susceptibility patterns of Gram-negative organisms isolated from the adult SOT recipients with documented sepsis with the hospital-wide inpatient antibiogram. To evaluate empiric antimicrobial coverage, we constructed a Weighted-Incidence Syndromic Combination Antibiogram (WISCA) by calculating the proportion of susceptible isolates per antimicrobial agent. We then compared the coverage rates against our institution's sepsis treatment guidelines.

Results: A total of 90 Gram-negative isolates comprised the SOT cohort, while the inpatient antibiogram cohort had 1328 isolates. Pseudomonas aeruginosa (27%) and Escherichia coli (31%) were the most common isolates in the SOT and inpatient antibiogram cohorts, respectively. Overall, antimicrobial resistance rates were higher in the SOT population compared to the hospital-wide inpatient antibiogram population. WISCA analysis showed imipenem was active for 59% of isolates as opposed to the institutional recommendation of piperacillin-tazobactam, which covered 39% of SOT isolates.

Conclusion: Current empiric antimicrobial recommendations for SOT patients are based on data from the general patient population, which may not accurately reflect the resistance patterns in this unique population. Utilizing patient population-specific antibiograms may improve empiric antimicrobial therapy and warrants further research.

Background: Kidney transplant (KT) recipients at intermediate risk for cytomegalovirus (CMV) infection constitute a potential target for individualized prevention strategies informed by the CMV-specific cell-mediated immunity (CMV-CMI). The optimal method for the functional assessment of CMV-CMI in this group remains unclear.

Methods: We included 74 CMV-seropositive KT recipients that did not receive T-cell-depleting induction and were managed by preemptive therapy. CMV-CMI was monitored at baseline and months 1, 3, 6, and 12 by intracellular cytokine staining (ICS) and a interferon (IFN)-γ-release assay (QuantiFERON-CMV [QTF-CMV]). Both methods were compared for discriminative capacity (areas under the receiving operating characteristic curve [auROCs]) and diagnostic accuracy to predict protection against high-level (≥1000 IU/mL) CMV DNAemia and/or disease.

Results: Eighteen patients (24.3%) experienced high-level CMV DNAemia or disease. There were no significant differences in the discriminative capacity to predict protection of CMV-specific CD8+ (auROC: 0.719) and CD4+ T-cell counts (auROC: 0.664) enumerated by ICS and IFN-γ production measured by QTF-CMV (auROC: 0.666). Optimal cutoff values of ≥9.8 CMV-specific CD4+ T-cells/µL and ≥5.7 CD8+ T-cells/µL by ICS yielded excellent specificity (95.7% and 86.9%, respectively) and positive predictive values (PPVs) (>98.0%), but a sensitivity below 60%. A reactive QTF-CMV (IFN-γ ≥0.2 IU/mL) provided good sensitivity (81.6%) and PPV (92.5%), at the expense of a poor specificity (22.2%).

Conclusions: The discriminative capacity to predict immune protection against clinically relevant CMV infection among intermediate-risk KT recipients was comparable for ICS and QTF-CMV. A selected ICS threshold may provide better specificity than the interpretative cut-off values currently recommended for QTF-CMV.

Background: Recurrent urinary tract infections (rUTIs) are common in kidney transplant recipients (KTRs). We aimed to assess the impact of rUTI on medical morbidity and quality of life (QOL).

Methods: Single-center, retrospective review of adult KTRs with rUTI during March 1, 2022 to February 28, 2023. QOL was assessed via the Recurrent UTI Impact Questionnaire (RUTIIQ) using a 10-point Likert scale.

Results: Among 46 KTRs, the median age was 59.5 years, and 82.6% were women. Median time since transplant was 50.1 months; most were on tacrolimus, mycophenolate, and prednisone. Chronic kidney disease was present in 60.9%. Predominant uropathogens were Escherichia coli (54.3%) and Klebsiella pneumoniae (43.5%); 37% of patients had multidrug-resistant organisms. Sixty-five percent had UTI-related hospitalization, and 69.6% needed intravenous antibiotics during the study period. Among 27 survey respondents, patients had generalized anxiety (median score 7), disrupted sleep (median score 5), and anxiety regarding sex life (median score 8.5). Work and daily activities were impaired, with a median score of 9 for regularly missing days of work or home responsibilities due to UTI. While there was high satisfaction with the content of medical care (median score 9), lower scores were noted for aspects such as feeling listened to by healthcare providers (median score 4) and access to specialists (median score 3).

Conclusion: Recurrent UTI is associated with a significant impact on morbidity and adverse QOL in KTRs, with female recipients bearing a disproportionate burden. Clinicians must adopt a proactive approach to managing risk factors, optimizing graft function, and implementing prevention measures to minimize the burden of rUTIs in KTRs.