Transplant Infectious Disease最新文献

Background: Community-acquired respiratory virus (CARV) infections are frequent and potentially severe in allogeneic hematopoietic stem cell transplant (allo-HCT) recipients. However, their impact during the peri-engraftment period remains underexplored.

Methods: In this retrospective multicenter study, we assessed the characteristics, effects on neutrophil engraftment, and risk factors for lower respiratory tract disease (LRTD) progression and 100-day mortality of symptomatic peri-engraftment CARV infections [from Day -8 until Day +36 after stem cell infusion]. A total of 112 allo-HCT recipients and 114 CARV episodes were included. Univariable and multivariable Cox regression analyses and cumulative incidence estimates were used.

Results: The median patient age was 51 years. Rhinovirus (47%) and respiratory syncytial virus (23%) were the most common pathogens. Half of the infections occurred before neutrophil engraftment (median day +18), and 50% progressed to LRTD. The 100-day mortality rate was 17%, increasing to 27% in those with LRTD. CARV infection prior to engraftment was associated with delayed neutrophil recovery (Day +18 vs. +16; p = 0.04) in multivariable cause-specific Cox regression analysis (HR 0.42, p < 0.001). Multivariable analysis identified lymphocyte count <0.2×10⁹/L (HR 3.1, p = 0.004) and active graft-versus-host disease (HR 2.36, p = 0.004) as independent predictors of LRTD. Risk factors for 100-day mortality included LRTD (HR 3.34, p = 0.04), use of anti-thymocyte globulin (HR 3.48, p = 0.019), and bacterial coinfection (HR 4.48, p = 0.006).

Conclusion: CARV infections during the peri-engraftment allo-HCT phase carry a high risk for delayed engraftment and LRTD in case of profound lymphopenia and GvHD. LRTD, ATG use, and bacterial coinfections contributed significantly to mortality.

Purpose: Beta-lactam allergies (BLAs) are commonly reported and may include true allergy or adverse effects. BLAs can lead to the use of suboptimal antimicrobials, resulting in adverse outcomes. At our institution, cefazolin is the preferred surgical prophylaxis for renal transplant (RT), with clindamycin used for BLAs. There is limited data available examining outcomes with the use of non-standard surgical site prophylaxis in RT.

Methods: This study evaluated 1523 adult RT patients from December 1, 2019 to December 1, 2024, with 257 (16.9%) having a documented BLA. BLA reactions were classified as immediate/allergic and non-allergic. Secondary outcomes included surgical site infections (SSIs) within 30 days and Clostridium difficile within 60 days, and were compared between groups that received cefazolin and clindamycin.

Results: A total of 13.0% of the population had true allergic-type reaction. The most common BLA was to penicillins (71.2%), then cephalosporins (46%) or multiple classes (10.8%). Allergic-type reactions were reported by 186 (72.4%), and non-allergic reactions were reported by 35 (13.6%), with 12 patients reporting both types, and 24 without recorded reactions. The most common immediate/allergic reaction was hives/rash (155 patients). The most common non-allergic reaction was gastrointestinal symptoms. For perioperative prophylaxis, 182 patients received clindamycin and 67 received cefazolin. There was no difference in C. difficile in the first 60 days. There was a higher rate of SSI in the first 30 days in patients who received clindamycin (29/182, 15.9%) compared to cefazolin (2/67, 2.99%), p = 0.006.

Conclusion: BLA is commonly reported, but the type of reactions should be critically evaluated, as non-standard antibiotics may increase SSI risk.

Background: Invasive infection may be the first prompt to investigate the occult presence of a plasma cell neoplasm. The objective of this study was to quantify the risk for subsequent diagnosis of a plasma cell neoplasm following bloodstream infection (BSI).

Methods: Statewide population-based surveillance was conducted from January 1 2000 - December 31 2019. Statewide databases were used to identify patients with incident plasma cell neoplasms diagnosed within 1-year following a BSI diagnosis.

Results: A cohort of 90 individuals who had BSI within the year preceding diagnosis of plasma cell neoplasm and 95 753 patients with BSI without this malignancy were included. The time to diagnose a plasma cell neoplasm was a median 123 (31-221) days after index BSI. The overall incidence of plasma cell neoplasms among those with incident BSI was 93.9 per 100 000 population annually. Among the study population, development of a BSI was associated with a 13-fold increased risk for diagnosis of plasma cell neoplasm (IRR; 12.9; 95% CI, 10.3-15.8; p < 0.001). The increased risk following BSI was elevated for both sexes, with a magnitude of risk higher for females (IRR; 14.0; 95% CI, 9.8-19.4). Streptococcus pneumoniae BSI was associated with the highest risk for subsequent diagnosis of a plasma cell neoplasm (IRR 46.9; 95% CI; 26.2-77.4).

Conclusions: The presence of a BSI, particularly with S. pneumoniae, is a marker for occult plasma cell neoplasms in a small but significant number of patients. Further studies are warranted to identify occult neoplastic disease investigation strategies for patients with incident BSIs.