Transplant Infectious Disease最新文献

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.

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: Adenovirus infection (AdVi) causes significant morbidity and mortality in allogeneic hematopoietic stem cell transplantation (allo-HCT) recipients.

Methods: This retrospective study of 131 patients (2020-2024) compared systematic monitoring in high-risk patients versus symptom-based testing in standard-risk patients.

Results: The 1-year incidence of AdV DNAemia was 19.8%, with AdV disease at 5.3%, being higher in the routine monitoring cohort (26%) than in the symptom-based cohort (11%, p = 0.031). Neither infection nor monitoring strategy impacted outcomes. The machine learning model identified predictive factors for early AdV DNAemia: age (50-65 years), diagnosis of acute leukemia or myelodysplastic syndrome, transplant from an HLA-matched unrelated or haploidentical donor, and non-myeloablative conditioning. Cost-effectiveness analysis showed that risk-based testing was optimal (€149 per additional detected case), while universal monitoring was excessively costly (€1006 per additional detected case).

Conclusion: In conclusion, although AdVi was common, routine monitoring did not improve outcomes and was financially burdensome, suggesting that a machine learning-driven risk-based testing strategy enhances cost-effectiveness while ensuring timely AdV detection and intervention.

The recent international resurgence of measles has led to significant public health concerns and poses significant risks to immunocompromised patients, including those who have undergone solid organ transplantation (SOT). SOT recipients may present atypically and are at an increased risk of severe complications of measles infection, underscoring the importance of preventative measures. This review summarizes contemporary data regarding measles transmission, the clinical presentation, diagnosis, and treatment of SOT recipients, as well as strategies for measles prevention, infection control considerations, postexposure prophylaxis, and opportunities for the mitigation of donor-derived measles and measles vaccine viruses.

Background: The efficacy and safety of nucleos(t)ide analogs is currently a critical issue in the treatment of hepatitis B virus infection. We aimed to investigate the long-term efficacy and safety profile of tenofovir alafenamide (TAF) treatment in the liver transplant recipients (LTRs).

Methods: This retrospective study was conducted with 72 LTRs who received TAF as sequential therapy after tenofovir disoproxil fumarate (TDF). The renal, metabolic outcomes, and efficacy of TAF were evaluated. In addition, some parameters were evaluated separately according to the use of calcineurin inhibitors.

Results: Following TAF treatment, median serum phosphorus levels and estimated glomerular filtration rate (eGFR) increased significantly in the overall cohort (from 2.4 to 2.85 mg/dL [p < 0.001]; from 66 to 74 mL/min/1.73 m² [p = 0.028], respectively). These improvements were more pronounced in patients with baseline hypophosphatemia and reduced eGFR. However, no significant changes were observed in eGFR staging. A categorical worsening of lipid profile was noted based on the NCEP ATP-III criteria, with increases in some lipid parameters. No significant weight gain or increase in the incidence of posttransplant diabetes mellitus was observed. Antiviral efficacy was maintained following the switch from TDF to TAF. In addition, no significant changes in immunosuppressive drug dosing were required, and no adverse events related to TAF were reported.

Conclusion: TAF was well-tolerated and effective in LTRs. The long-term benefits of TAF on hypophosphatemia, renal function, and effective viral suppression were demonstrated. The patients with an increased risk of cardiovascular disease should receive more intensive monitoring for changes in their lipid profile.