scholarly journals Targeting Asymptomatic Bacteriuria in Antimicrobial Stewardship: the Role of the Microbiology Laboratory

2020 ◽  
Vol 58 (5) ◽  
Author(s):  
Zanthia Wiley ◽  
Jesse T. Jacob ◽  
Eileen M. Burd
Keyword(s):  
Renal Transplant ◽  
Pregnant Women ◽  
Bacterial Species ◽  
Asymptomatic Bacteriuria ◽  
Urine Specimen ◽  
Diabetic Patients ◽  
Solid Organ ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Cord Injury

ABSTRACT This minireview focuses on the microbiologic evaluation of patients with asymptomatic bacteriuria, as well as indications for antibiotic treatment. Asymptomatic bacteriuria is defined as two consecutive voided specimens (preferably within 2 weeks) with the same bacterial species, isolated in quantitative counts of ≥105 CFU/ml in women, including pregnant women; a single voided urine specimen with one bacterial species isolated in a quantitative count ≥105 CFU/ml in men; and a single catheterized urine specimen with one or more bacterial species isolated in a quantitative count of ≥105 CFU/ml in either women or men (or ≥102 CFU/ml of a single bacterial species from a single catheterized urine specimen). Any urine specimen with ≥104 CFU/ml group B Streptococcus is significant for asymptomatic bacteriuria in a pregnant woman. Asymptomatic bacteriuria occurs, irrespective of pyuria, in the absence of signs or symptoms of a urinary tract infection. The two groups with the best evidence of adverse outcomes in the setting of untreated asymptomatic bacteriuria include pregnant women and patients who undergo urologic procedures with risk of mucosal injury. Screening and treatment of asymptomatic bacteriuria is not recommended in the following patient populations: pediatric patients, healthy nonpregnant women, older patients in the inpatient or outpatient setting, diabetic patients, patients with an indwelling urethral catheter, patients with impaired voiding following spinal cord injury, patients undergoing nonurologic surgeries, and nonrenal solid-organ transplant recipients. Renal transplant recipients beyond 1 month posttransplant should not undergo screening and treatment for asymptomatic bacteriuria. There is insufficient evidence to recommend for or against screening of renal transplant recipients within 1 month, patients with high-risk neutropenia, or patients with indwelling catheters at the time of catheter removal. Unwarranted antibiotics place patients at increased risk of adverse effects (including Clostridioides difficile diarrhea) and contribute to antibiotic resistance. Methods to reduce unnecessary screening for and treatment of asymptomatic bacteriuria aid in antibiotic stewardship.

Detection of Toxoplasma Gondii Antibodies and DNA Among Renal Transplant Recipient and blood donor in Khartoum State, Sudan

2021 ◽  
pp. 135-141
Author(s):  
Elghazali Mohammed ◽  
Mustafa Yassin ◽  
Khalid Anan ◽  
Dina N Abdelrahman ◽  
Abdelrahim M. ElHussein ◽  
...  
Keyword(s):  
Toxoplasma Gondii ◽  
Renal Transplant ◽  
Transplant Recipient ◽  
Renal Transplant Recipient ◽  
Blood Donor ◽  
Blood Donors ◽  
Solid Organ ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Toxoplasma Gondii Infection

Background and Aim: Toxoplasma gondii infection arises in transplant recipient groups, but at varying frequencies. Reactivation of latent T. gondii infection in transplant patients is uncommon, but does occur. The incidence of reactivation is greater in patient groups receiving more aggressive immunosuppressive therapy. Early diagnosis and treatment should be considered in T. gondii-antibody-positive patients subjected to solid organ transplantation. The aim of this study was to estimate the seroprevalence of Toxoplasma gondii infection in renal transplant recipients in Khartoum, Sudan, using serological and molecular methods. Methods: This was a descriptive cross sectional, hospital based study, blood sample were collected from 108 participants; out of them 58 renal transplant recipient individuals and 50 healthy Blood donor attending Sudanese Kidney Association Hospital and Sudan Heart Center Blood Bank. Demographic data were collected by structured questionnaire. All samples were tested for anti-Toxoplasma IgG and IgM antibodies using ELISA, and PCR for detection of Toxoplasma DNA was performed. Results: The seropositivity of IgG anti-T. gondii antibodies was higher in renal transplant recipients than in blood donors (36.2% vs 32.0%). Anti-toxoplasma IgM was positive in one renal transplant recipient individual (1.70%), and no samples exhibit reactive IgM antibody for blood donors. None of the samples exhibited positivity to T.gondii DNA. Conclusion: the study showed a relatively high seroprevalence of T.gondii antibodies in renal transplant recipients and blood donor volunteers, on the other hand, the prevalence was much higher in the study conducted in pregnant woman in Sudan. Our study highlighted that asymptomatic blood donors, may constitute a significant risk of transmitting toxoplasmosis to susceptible recipients.

The association between renal resistive index and premature mortality after kidney transplantation is modified by pre-transplant diabetes status: a cohort study

2019 ◽  
Vol 35 (9) ◽  
pp. 1577-1584
Author(s):  
Jean-Baptiste de Freminville ◽  
Louis-Marie Vernier ◽  
Jérome Roumy ◽  
Frédéric Patat ◽  
Philippe Gatault ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Pulse Pressure ◽  
Predictive Value ◽  
Resistive Index ◽  
Renal Resistive Index ◽  
Diabetic Patients ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Diabetes Status

Abstract Background Renal resistive index (RI) predicts mortality in renal transplant recipients, but we do not know whether this is true in diabetic patients. The objective of this study was to analyse the long-term predictive value of RI for death with a functioning graft (DWFG) in renal transplant recipients with or without pre-transplant diabetes. Methods We conducted a retrospective study in 1800 renal transplant recipients between 1985 and 2017 who were followed for up to 30 years (total observation period: 14 202 patient years). Donor and recipient characteristics at time of transplantation and at 3 months were reviewed. The long-term predictive value of RI for DWFG and the age–RI and arterial pressure–RI relationships were assessed. Results A total of 284/1800 (15.7%) patients had diabetes mellitus before transplantation. RI was <0.75 in 1327/1800 patients (73.7%). High RI was associated with a higher risk of DWFG in non-diabetic patients [hazard ratio (HR) = 3.39, 95% confidence interval 2.50–4.61; P < 0.001], but not in patients with pre-transplant diabetes (HR = 1.25, 0.70–2.19; P = 0.39), even after multiple adjustments. There was no interaction between diabetes and age. In contrast, there was an interaction between RI and pulse pressure. Conclusion Our study indicates that RI is not a predictor of DWFG in diabetic renal transplant recipients, in contrast to non-diabetic recipients. These findings could be due to a different age–RI or pulse pressure–RI relationship.

P0863TYPE OF PROTON PUMP INHIBITOR AND RISK OF IRON DEFICIENCY IN RENAL TRANSPLANT RECIPIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Rianne M. Douwes ◽  
Joanna Sophia Jacoline Vinke ◽  
António W Gomes-Neto ◽  
Hans Blokzijl ◽  
Stefan P Berger ◽  
...  
Keyword(s):  
Cohort Study ◽  
Renal Transplant ◽  
Iron Deficiency ◽  
Proton Pump ◽  
Ferritin Level ◽  
Solid Organ ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Increased Risk ◽  
Different Types

Abstract Background and Aims Use of proton-pump inhibitors (PPIs) is common practice in renal transplant recipients (RTRs). Emerging data suggest several adverse effects of use of PPIs, including development of iron deficiency (ID). Although the latter has been shown with respect to PPIs, specific analyses for different types of PPIs and the associated risk of ID have not been performed. Method We used data from the TransplantLines Biobank and Cohort study, an ongoing prospective cohort study among all types of solid organ transplant recipients. For the current study, we used data from stable RTRs with a functional graft for more than 1 year post transplantation (n=795). We excluded RTRs who used any form of iron supplementation (n=54) and EPO-stimulating agents (n=24), resulting in 728 RTRs eligible for analyses. Use of PPIs was subdivided in different types of PPIs, i.e. omeprazole, esomeprazole, pantoprazole, and rabeprazole. ID was defined as TSAT<20% and ferritin <300 µg/L. Logistic regression analysis was used to assess the associations between PPIs and ID. Results We included 728 RTRs (age 56±13 years, 61% males), with a mean eGFR of 53±18 ml/min/1.73m2, a median [interquartile range] ferritin level of 96 (44 – 191) µg/L and mean TSAT of 24±10%. PPIs were used by 504 (69%) of the included RTRs, of which 398 (79%), 55 (11%), 49 (10%), and 2 (0.4%) respectively used omeprazole, pantoprazole, esomeprazole, and rabeprazole. Use of PPIs was strongly associated with ID (OR, 2.20; 95%CI 1.48 – 3.28; P<0.001), independent of adjustment for age, sex, BMI, eGFR, hs-CRP, smoking, alcohol use, use of calcineurine inhibitors, prednisolone, antiplatelet drugs, and antihypertensives. When subdividing the PPIs into the different types, both omeprazole (OR, 1.98; 95%CI 1.39 – 2.83; P<0.001) and esomeprazole (OR, 2.11; 95%CI 1.09 – 4.07; P=0.03) were independently associated with iron deficiency, whereas pantoprazole was not associated (OR, 0.89; 95%CI 0.47 – 1.70; P=0.73). Conclusion Omeprazole and esomeprazole, but not pantoprazole, are associated with an increased risk of ID. Our results are in line with previous reports that pantoprazole has the lowest potency with least increase in intragastric pH, thereby possibly interfering less with reduction of ferric to ferrous iron, and subsequently iron absorption. Future studies are warranted to confirm our present findings.

Seroreactivity Against HPV 16 E4 and E7 Proteins in Renal Transplant Recipients and Pregnant Women

1992 ◽  
Vol 98 (3) ◽  
pp. 389-390 ◽  
Author(s):  
Ingrid Jochmus-Kudielka ◽  
Jan N Bouwes Bavinck ◽  
Frans H J Claas ◽  
Achim Schneider ◽  
Fokko J van der Woude ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Pregnant Women ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Hpv 16 ◽  
E7 Proteins

scholarly journals Lower Respiratory Tract Infection in a Renal Transplant Recipient: Do not Forget Metapneumovirus

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
N. Noel ◽  
B. Rammaert ◽  
J. Zuber ◽  
N. Sayre ◽  
M. F. Mamzer-Bruneel ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Organ Transplant ◽  
Detection Methods ◽  
Solid Organ ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Solid Organ Transplant Recipients

Human metapneumovirus (hMPV) is emerging as a cause of a severe respiratory tract infection in immunocompromised patients. hMPVpneumonia has only been seldom reported in nonpulmonary solid organ transplanted patients, such as renal transplant recipients. We report here a case of a 39-year-old patient presenting with fever, cough, and interstitial opacities on CT scan diagnosed as a nonsevere hMPVpneumonia 11 years after a renal transplantation. Infection resolved spontaneously. Differential diagnosis withPneumocystispneumonia was discussed. We review the medical literature and discuss clinical presentation and detection methods that can be proposed in solid organ transplant recipients.

scholarly journals Outcome of treated and untreated asymptomatic bacteriuria in renal transplant recipients

2011 ◽  
Vol 26 (12) ◽  
pp. 4109-4114 ◽  
Author(s):  
E. B. E. Amari ◽  
K. Hadaya ◽  
L. Buhler ◽  
T. Berney ◽  
P. Rohner ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Asymptomatic Bacteriuria ◽  
Renal Transplant Recipients ◽  
Transplant Recipients

scholarly journals Invasive fungal infections: A diagnostic challenge

2017 ◽  
Vol 4 (2) ◽  
pp. 15
Author(s):  
Akshjot Puri ◽  
Michael Chesser ◽  
Thomas Lidner
Keyword(s):  
Squamous Cell Carcinoma ◽  
Renal Transplant ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Fungal Infections ◽  
Invasive Fungal Infections ◽  
Perineal Pain ◽  
Solid Organ ◽  
Renal Transplant Recipients ◽  
Transplant Recipients

Introduction: Overall incidence of invasive fungal infections in solid organ transplant recipients is low with the more common infections being invasive candidiasis, aspergillosis and cryptococosis. Zygomycosis comprises of only 0.2%-1.2% of infections in renal transplant recipients with current recommendations advising against routine prophylaxis.Case: The patient was a 60-year-old male with a history of renal transplant 25 years ago on immunosuppressants, chronic transplant glomerulopathy, squamous cell carcinoma post penectomy and bilateral orchiectomy 2 years ago, controlled diabetes and hypertension who presented with pain in the perineal region for 4 days. On exam he was discovered to be afebrile and had a scrotal skin fold with urethral opening from his previous surgery and 2.5 cm induration and tenderness in the left gluteal fold. He was treated with 5 days of Unasyn. A biopsy was taken to rule out recurrence of squamous cell carcinoma and he was discharged home. The patient returned with worsening perineal pain within 3 days. On exam he had progressive induration with erythema, swelling and tenderness in the perineum. An initial white blood cell count of 15.8 increased to 25.8 and blood cultures remained negative. The computed tomography scan showed diffuse edema in the perineum without any evidence of abscesses. Immunosuppression was held and broad spectrum antibiotics were started. His renal failure progressively worsened eventually requiring continuous renal replacement therapy, intensive care transfer and vasopressor support. The biopsy revealed intermingled fibrous tissue with focal necrosis and no evidence of malignant cells. A repeat incision and debridement (I&D) culture showed growth consistent with mucor. He was started on liposomal amphotericin B and taken to the OR for multiple debridements. Unfortunately he progressed to multisystem organ failure and died after transitioning to comfort care.Conclusions: Invasive fungal infections remain one of the life threatening differentials for cellulitis like skin lesions, especially for patients not responding to antibiotics and those who are immunocompromised. Early cultures and histopathology of lesions should be done for diagnosis and to avoid delays in treatment.

Impact of Pharmacogenetic Determinants of Tacrolimus and Mycophenolate on Adverse Events in Renal Transplant Patients

2021 ◽  
Vol 22 ◽  
Author(s):  
Kalluri Thishya ◽  
Boddupally Sreenu ◽  
Shree Bhushan Raju ◽  
Vijay Kutala
Keyword(s):  
Renal Transplant ◽  
Adverse Events ◽  
Metabolic Pathways ◽  
Early Stage ◽  
Maintenance Phase ◽  
Solid Organ ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Post Transplantation ◽  
Increased Risk

Background: Graft acceptance against immunity is one of themajor challenges in solid organ transplant. Immunosuppressive medications have effectively improved the post-transplantation outcome; however it has its own limitations. Genetic polymorphisms in drug-metabolizing enzymes have been identified as the potential targets in developing a pharmacogenetic strategy, to individualize drug dose and also in preventing the adverse events. Objective: The rationale of the study was to explore polymorphisms in tacrolimus and mycophenolate metabolic pathways that influence the adverse clinical outcomes in renal transplant recipients. Methods: A total of 255 renal transplant recipients were analyzed for the pharmacogenetic determinants of tacrolimus (CYP3A5*3, ABCB1 1236 T>C, ABCB1 2677 G>A/T, ABCB1 3435 T>C) and mycophenolate (UGT1A8*3, UGT1A9, IMPDH I, IMPDH II c.787C>T , ABCC2 -24 C>T and c.3972C>T) using Sanger sequencing. Results: Acute rejection (AR) was observed in 5.88% of the transplant recipients, whereas, acute tubular necrosis (ATNs) was observed in 7.45% of the patients, within early stage of the maintenance phase. Infections, such as urinary tract infection (UTI) and cytomegalovirus (CMV) infection were observed in 11.37% and 12.16% of the patients. The AUC of mycophenolate was significantly higher in patients with increased risk for infections. ABCC2 -24 C>T, c.3972C>T polymorphisms and ABCB1 3435 C-allele, were associated with reduced risk for infections. ABCC2 rs3740066 was associated with 2.06-fold all-cause mortality risk. CYP3A5 AG- and UGT1A9-440 CC-genotypes showed increased risk, and ABCC 3972C>T, CC-genotype showed protection against adverse events. Conclusion: Genetic variants in tacrolimus and mycophenolate metabolic pathways were found to influence the morbidity and mortality in renal transplant recipients.

Post-Renal Transplant De Novo Non-Skin Malignancies in Mycophenolate Mofetil- and Calcineurin Inhibitor-Based Immunosuppression.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1683-1683
Author(s):  
Lohith Bachegowda ◽  
Diptesh Gupta ◽  
Ajoy Bharadwaj ◽  
Karthik Ranganna ◽  
TIM Adamowicz ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Renal Transplant ◽  
Calcineurin Inhibitor ◽  
De Novo ◽  
Calcineurin Inhibitors ◽  
Solid Organ ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Hla Antigen ◽  
Post Transplant

Abstract Abstract 1683 Poster Board I-709 Introduction- Post-transplant malignancy is one of the major complications of immunosuppression in kidney transplant recipients. Mycophenolate Mofetil(MMF) and Calcineurin inhibitors(CNI) based immunosuppression is a well established combination in clinical practice. MMF has an action on cell proliferation by inhibiting Inosine Mono Phosphate dehydrogenase. However, its antitumor properties have been constantly debated. It is shown to have some antiproliferative effects in leukemias and lymphomas with a decreased incidence of PTLD. This single center study evaluated the effect of combining mycophenolate mofetil (MMF) with calcineurin inhibitors on the incidence of de novo post-transplant non skin malignancies in renal transplant recipients. We also compared the incidence of solid versus liquid cancers. Patients and Methods- Six hundred and fifty seven (657) consecutive kidney and kidney/pancreas recipients transplanted between January 2000 and December 2005 were analyzed for post-transplant malignancies. Three hundred and sixty two (362) recipients were maintained on a calcineurin inhibitor and MMF combination. The incidence of neoplasm in this group was monitored till June 2009. All patients received induction therapy with basiliximab and methylprednisolone. Steroid therapy was discontinued after the second dose in the withdrawal group. In the steroid treated group oral prednisone was initiated on day 2 at 30 mg per day and rapidly tapered to 5 mg per day at one month and continued for the life of the graft. Maintenance therapy in all recipients included both, a calcineurin inhibitor and mycophenolate mofetil (MMF). All clinical acute rejections were confirmed by biopsy and treated with intravenous methylprednisolone. Steroid unresponsive rejections were treated with Thymoglobulin Table 1 shows the demography in the CNI + MMF recipient group Recipient demography Calcineurin inhibitor/MMF group Number of recipients 362 Mean age in years 53 ± 3 Male gender 196 Deceased donor kidney recipients 305 Mean HLA antigen mismatch 3.95 ± 2.6 Pre-transplant malignancies 0 Number of recipients with rejection 71 Table 2 Incidence and type of malignancies in calcineurin inhibitor + MMF group Type of cancer Calcineurin inhibitor/MMF group Total number of recipients 362 Post transplant lymphoproliferative disease 1 Hodgkin's lymphoma 1 Renal cell cancer 6 Lung cancer 3 Prostate cancer 2 Colon cancer 2 Breast cancer 2 Bladder cancer 1 Pancreatic cancer 1 Leukemia 1 Thyroid cancer 1 Total cancers 21 (5.8%) Conclusion In our study on CNI/MMF based immunosuppression in renal transplant patients, 5.8% developed various neoplasms. There was a lower incidence of hematologic- malignancies 3/362(0.8%) in comparison to solid organ neoplasm 18/362(4.97%). The incidence of PTLD was 0.27%, which is similar to other observational studies. This could partly be due to greater expression of Inosine Monophosphate, inhibited by MMF in malignant hematologic cells. Further multicenter analysis needs to be done to detect the incidence of liquid and solid neoplasms, correlating with intracellular IMP levels with MMF usage in renal transplant recipients. Disclosures No relevant conflicts of interest to declare.

scholarly journals Perioperative fosfomycin disodium prophylaxis against urinary tract infection in renal transplant recipients: a randomized clinical trial

2020 ◽  
Vol 35 (11) ◽  
pp. 1996-2003 ◽  
Author(s):  
Rodrigo Rosado-Canto ◽  
Idalia Parra-Avila ◽  
Javier Tejeda-Maldonado ◽  
Cristopher Kauffman-Ortega ◽  
Francisco T Rodriguez-Covarrubias ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Placebo Group ◽  
Urinary Tract ◽  
Renal Transplant ◽  
Tract Infection ◽  
Asymptomatic Bacteriuria ◽  
Attractive Alternative ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
The Mean

Abstract Background Symptomatic urinary tract infection (UTI) is the most common infectious complication in renal transplant recipients (RTRs). Fosfomycin (FOS) is an attractive alternative for prophylaxis because it does not interact with immunosuppressants; although 90% is excreted unchanged in the urine, it does not require adjustment for renal function for single dose prophylaxis. Methods RTRs were recruited into this randomized, double-blind, placebo-controlled trial. Participants were randomized (1:1) to receive one 4 g dose of FOS disodium intravenously 3 h (FOS group) or placebo (placebo group) before placement and removal of a urinary catheter and before removal of a double-J ureteral stent. All participants received prophylaxis with trimethoprim/sulfamethoxazole. The main outcome was a comparison of the mean number of symptomatic UTI and asymptomatic bacteriuria (AB) episodes per patient during a 7-week follow-up period. The study was registered at ClinicalTrials.gov, NTC03235947. Results Eighty-two participants were included (41 in the FOS group and 41 in placebo group). The mean number of AB or symptomatic UTI episodes per patient was lower in the FOS group [intention-to-treat (ITT) 0.29 versus 0.60, P = 0.04]. The incidence of symptomatic UTI was lower in the FOS group (ITT, 7.3% versus 36.6%, P = 0.001), and there was no difference in the incidence of AB between both groups. The incidence of adverse events was similar in both groups. Conclusions FOS addition is an effective and safe strategy to reduce the number of symptomatic UTIs during the first 7 weeks after renal transplant.

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