Diagnostic and therapeutic approach to infectious diseases in solid organ transplant recipients

Timsit, Jean François; Sonneville, Romain; Kalil, André C.; Bassetti, Matteo; Ferrer, Ricard; Jaber, Samir; Lanternier, Fanny; Luyt, Charles Edouard; MacHado, Flavia F.R.; Mikulska, Małgorzata; Papazian, Laurent; Pène, Frédéric; Poulakou, Garyphalia; Viscoli, Claudio; Wolff, Michel; Zafrani, Lara; Delden, Christian van

doi:10.1007/s00134-019-05597-y

Cited by 66 publications

(45 citation statements)

References 121 publications

(126 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Preventing these infections will be a major challenge. Indeed, many of these infections involve the surgical site and the allograft itself, and are favored by surgical complications including anastomotic leaks and strictures, undrained collections, and indwelling catheters [ 3 , 33 , 34 ]. Major efforts to reduce these risk factors, including improved surgical techniques, adequate source control, and early removal of indwelling catheters and prosthetic material will be essential.…”

Section: Discussionmentioning

confidence: 99%

Burden and Timeline of Infectious Diseases in the First Year After Solid Organ Transplantation in the Swiss Transplant Cohort Study

Delden

Stampf

Hirsch

et al. 2020

Clinical Infectious Diseases

Self Cite

189

167

View full text Add to dashboard Cite

Background The burden and timeline of posttransplant infections are not comprehensively documented in the current era of immunosuppression and prophylaxis. Methods In this prospective study nested within the Swiss Transplant Cohort Study (STCS), all clinically relevant infections were identified by transplant–infectious diseases physicians in persons receiving solid organ transplant (SOT) between May 2008 and December 2014 with ≥12 months of follow-up. Results Among 3541 SOT recipients, 2761 (1612 kidney, 577 liver, 286 lung, 213 heart, and 73 kidney-pancreas) had ≥12 months of follow-up; 1520 patients (55%) suffered 3520 infections during the first year posttransplantation. Burden and timelines of clinically relevant infections differed between transplantations. Bacteria were responsible for 2202 infections (63%) prevailing throughout the year, with a predominance of Enterobacteriaceae (54%) as urinary pathogens in heart, lung, and kidney transplant recipients, and as digestive tract pathogens in liver transplant recipients. Enterococcus spp (20%) occurred as urinary tract pathogens in kidney transplant recipients and as digestive tract pathogens in liver transplant recipients, and Pseudomonas aeruginosa (9%) in lung transplant recipients. Among 1039 viral infections, herpesviruses predominated (51%) in kidney, liver, and heart transplant recipients. Among 263 fungal infections, Candida spp (60%) prevailed as digestive tract pathogens in liver transplant recipients. Opportunistic pathogens, including Aspergillus fumigatus (1.4%) and cytomegalovirus (6%), were rare, scattering over 12 months across all SOT recipients. Conclusions In the current era of immunosuppression and prophylaxis, SOT recipients experience a high burden of infections throughout the first year posttransplantation, with rare opportunistic pathogens and a predominance of bacteria.

show abstract

Section: Discussionmentioning

confidence: 99%

Burden and Timeline of Infectious Diseases in the First Year After Solid Organ Transplantation in the Swiss Transplant Cohort Study

Delden

Stampf

Hirsch

et al. 2020

Clinical Infectious Diseases

Self Cite

189

167

View full text Add to dashboard Cite

show abstract

“…Patients after solid organ transplantation are at increased risk for nosocomial infections due to multidrug-resistant bacteria [15] and particularly to VRE bacteraemia [10,16,17]. Mortality rates up to 46% in the context of VRE bacteraemia have been described in these patients [10].…”

Section: Introductionmentioning

confidence: 99%

Does vancomycin resistance increase mortality in Enterococcus faecium bacteraemia after orthotopic liver transplantation? A retrospective study

Dubler

Lenz

Zimmermann

et al. 2020

Antimicrob Resist Infect Control

View full text Add to dashboard Cite

Background: The relevance of vancomycin resistance in enterococcal blood stream infections (BSI) is still controversial. Aim of this study was to outline the effect of vancomycin resistance of Enterococcus faecium on the outcome of patients with BSI after orthotopic liver transplantation (OLT). Methods: The outcome of OLT recipients developing BSI with vancomycin-resistant (VRE) versus vancomycinsusceptible Enterococcus faecium (VSE) was compared based on data extraction from medical records. Multivariate regression analyses identified risk factors for mortality and unfavourable outcomes (defined as death or prolonged intensive care stay) after 30 and 90 days. Results: Mortality was similar between VRE-(n = 39) and VSE-(n = 138) group after 30 (p = 0.44) or 90 days (p = 0.39). Comparable results occurred regarding unfavourable outcomes. Mean SOFA Non-GCS score during the 7-dayperiod before BSI onset was the independent predictor for mortality at both timepoints (HR 1.32; CI 1.14-1.53; and HR 1.18; CI 1.08-1.28). Timely appropriate antibiotic therapy, recent ICU stay and vancomycin resistance did not affect outcome after adjusting for confounders. Conclusion: Vancomycin resistance did not influence outcome among patients with Enterococcus faecium bacteraemia after OLT. Only underlying severity of disease predicted poor outcome among this homogenous patient population. Trial registration: This study was registered at the German clinical trials register (DRKS-ID: DRKS00013285).

show abstract

“…Despite advances in liver transplantation, morbidity and mortality due to infectious complications remain the biggest problem [114,115]. In many centers, infection is the leading cause of death after liver transplantation, particularly after the first year [116].…”

Section: Early Infection In Liver Transplantationmentioning

confidence: 99%

“…Abdominal and lung infection are the most common, both associated with the presence of bacteremias [115].…”

Section: Antibiotics Have Interactions With Immunosuppressive Medicatmentioning

confidence: 99%

Early Postoperative Monitoring of the Liver Graft

Civantos¹,

Cantero²,

Marcos³

et al. 2021

Liver Pathology

View full text Add to dashboard Cite

Liver transplantation (LT) is a common current technique for end-stage liver disease. Complications after the surgical procedure, though uncommon, can be of very different origin and can also be severe enough to lead to liver and multiorgan failure and finally graft loss and/or recipient's death. Intensivists and the surgical team must be familiarized with these early complications to detect them as soon as possible in order to use the best diagnostic tools and take the best therapeutic measures to restore anatomical integrity and organ function to optimize the liver graft. In this chapter, we present an updated state of the art for efficiently tackling with all different, most usual complications that an LT patient can present during early postoperative period.

show abstract

Diagnostic and therapeutic approach to infectious diseases in solid organ transplant recipients

Cited by 66 publications

References 121 publications

Burden and Timeline of Infectious Diseases in the First Year After Solid Organ Transplantation in the Swiss Transplant Cohort Study

Burden and Timeline of Infectious Diseases in the First Year After Solid Organ Transplantation in the Swiss Transplant Cohort Study

Does vancomycin resistance increase mortality in Enterococcus faecium bacteraemia after orthotopic liver transplantation? A retrospective study

Early Postoperative Monitoring of the Liver Graft

Contact Info

Product

Resources

About