Objectives: To determine whether microbial contamination of preservation solution (PS) in kidney transplantation is associated with donor-derived infections (DDIs). Methods: We retrospectively analysed data from 1077 deceased kidney transplant recipients of 560 donors. In all, 1002 PS samples were collected for microbiological assessment to establish the incidence and distribution of contamination. Comparisons between patients with contaminated PS and those with sterile PS were performed to assess the impact of microbial contaminations in perfusate on probable donor-derived infections (p-DDIs), and potential risk factors for p-DDIs were examined. Results: The contamination rate of PS was 77.8% (402/517). Bacterial species accounted for 85.6% (887/ 1036) of the total 1036 isolated microorganisms and 26.5% (275/1002) of the recipients' PS were contaminated by ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp.). Enterococcus predominated the microbiological pattern. The incidence of infection was significantly higher in patients with microbial contamination than in patients with sterile PS (13.8% (107/776) versus 7.1% (16/226), p 0.006). The prevalence of p-DDIs was significantly higher in patients with ESKAPE contamination than in patients with other bacterial contamination in PS (7.2% (18/251) versus 1.0% (4/405), p 0.000). Univariate analysis indicated that ESKAPE contamination increased the risk of p-DDIs (p 0.001, OR 3.610, 95% CI 1.678 e7.764). Multivariate analysis determined ESKAPE contamination as the only independent risk factor associated with p-DDIs (OR 3.418, 95% CI 1.580e7.393). Conclusions: The high rate of microbial contaminations in PS is unusual and probably due to poor surgical procedures. Patients whose PS are contaminated by ESKAPE pathogens could have a significantly increased risk of p-DDIs at early post-transplantation.

Despite advancements in modern medicine, the treatment of acute heart failure (AHF) after acute myocardial infarction (AMI) remains challenging. Milrinone is effective in the treatment of chronic congestive heart failure, but its safety and efficacy in patients with AHF after AMI have not been systematically evaluated. This meta-analysis was performed to assess the safety and efficacy of milrinone in patients with AHF after AMI. We used a pre-designed protocol to search electronic databases for randomized trials assessing milrinone for the treatment of AHF after AMI. Data were abstracted from relevant studies. Heteroge-neity was assessed qualitatively using a Q test and quantified using the I 2 statistic. Pooled risk estimates with 95% confidence intervals (CIs) were obtained using fixed-effects models unless substantial heterogeneity was observed (I 2 ≥ 50% and heterogene-ity p ≤ 0.1). Four randomized trials met the inclusion criteria. However, there were no significant differences in deaths, blood pressure, premature ventricular contractions, gastrointestinal reactions, or ventricular tachycardia or fibrillation (all p > 0.05) between control group and milrinone treatment group. Pooled estimates showed that milrinone significantly increased the left ventricular ejection fraction (MD 5.69; 95% CI 4.27 to 7.10; p < 0.00001) and cardiac output (MD 0.35, 95% CI: 0.13 to 0.56; p = 0.002, I 2 = 24%). While studies to date are few and limited by small sample sizes and poor quality, they suggest that treatment with milrinone may be safe and effective for patients with AHF after AMI. However, this meta-analysis did not show that milrinone could improve prognosis or the survival rate. Despite the substantial progress in medicine in recent decades [1], acute myocardial infarction (AMI) remains one of the leading causes of death and disability around the world [2,3]. After an AMI, about 40% of patients develop left ventricular dysfunction [4], and acute heart failure (AHF) is a common complication of AMI. The AHF epidemic, with its high morbidity , mortality, readmissions and costs, represents a tremendous challenge to the healthcare community and society as a whole [5-7]. Thus, successful treatment of AHF after AMI still remains a difficult task to accomplish. Decreased cardiac contractility plays a central role in sys-tolic AHF, making positive inotropics an essential part of AHF treatment [8]. Milrinone is a type III phosphodiesterase (PDE) inhibitor that can prevent the degradation of adenosine monophosphate-cAMP, thus leading to an increase in calcium ion concentration and ultimately improving myocardial con-tractility [9,10]. By increasing the cAMP concentration, PDE inhibitors also increase the removal of calcium from the vas-cular smooth muscle cells [11]. This, in turn, leads to cellular relaxation and vasodilation. Therefore, in addition to being a positive inotropic, milrinone also decreases the afterload. Milrinone has been widely used to support circulation in patients with severe AHF and acute exacerbations ...