Favorable outcome in a renal transplant recipient with donor‐derived infection due to multidrug‐resistant Pseudomonas aeruginosa

Abstract

Most cases of donor-derived infection due to Pseudomonas aeruginosa reported in the literature are associated with vascular dehiscence, all of which resulted either in death or graft failure requiring graft removal. We report the successful treatment of donor-derived infection due to multidrug-resistant P. aeruginosa in a 64-year-old male who presented with bacteremia and peritransplant renal fluid collection after undergoing deceased-donor renal transplantation. As a result of the report of positive donor cultures by the host Organ Procurement Organization, the infection was promptly identified by blood cultures drawn before appearance of symptoms. Surveillance blood cultures in recipients are not usually recommended. However, they should be done if donor cultures turn positive. Therefore, it is crucial to perform cultures in donors and to closely follow them up for early identification and prompt treatment of donor-transmitted infections due to organisms like P. aeruginosa that can be graft and/or life threatening.

Outcome of Transplantation Using Organs From Donors Infected or Colonized With Carbapenem-Resistant Gram-Negative Bacteria

“…A thorough review of donor cultures and uniform protocols of antibiotic treatment for recipients of organs from donors infected with MDR bacteria have now been implemented at our institute. Recent reports (16)(17)(18)(19)(20) have shown that bacterial transmission can occur when posttransplant antibiotic therapy is not used in patients with postprocurement positive cultures. Ariza-Heredia et al and Goldberg et al (17,18) suggest that targeted antimicrobial treatment following transplantation can prevent transmission of MDR gram-negative pathogens, as reported for organisms with a narrower resistance profile.…”

“…CRE are the source of outbreaks and can be highly lethal, with a mortality rate of 40% in SOT recipients (14). There are few reports available on the optimal evaluation and management of these highly resistant bacteria in SOT donors and recipients (15)(16)(17)(18)(19)(20). In Italy, donors with bacteremia caused by carbapenemresistant gram-negative (CRGN) bacteria are routinely excluded for any organ donation.…”

Donor Derived Pseudomonas Infeciton in Deceased Donor Kidney Transplantation

“…Mevcut çalışma nakil tipi (3)(4)(5) . Özellikle solunum yollarında gelişen pseudomonas enfeksiyonlarının innominat arter yolu ile sistemik dolaşıma geçtiği yönünde raporlar mevcuttur (6) .…”

“…Özellikle solunum yollarında gelişen pseudomonas enfeksiyonlarının innominat arter yolu ile sistemik dolaşıma geçtiği yönünde raporlar mevcuttur (6) . Nakil sonrası erken dönemde P.aeruginosa enfeksiyonunun arter anastomozunda pseudoanevrizma ve ayrışmaya neden olabileceği gösterilmiştir (3,5,7) (Tablo 1). Bu durum genellikle greft veya hasta kaybıyla sonuçla-nır.…”

“…Bu durum genellikle greft veya hasta kaybıyla sonuçla-nır. Bakterinin salgılamış olduğu elastaz enzimi, doğrudan olarak endoteliyal hücre ve bazal membran hasarına ve damar duvarından kanamalara neden olmaktadır (5)(6)(7)(8) . Solid organ transplantasyonlarında olası donör kaynaklı enfeksiyonu önlemeye yönelik önlemlere rağmen, %0,2-6 civarında enfeksiyon geçişi rapor edilmektedir.…”