Carbapenemase-Producing Klebsiella pneumoniae Colonization and Infection in Solid Organ Transplant Recipients: A Single-Center, Retrospective Study

Carbapenemase-KPC producing Klebsiella pneumoniae (CP-Kp) infection represents a serious threat to solid organ transplant (SOT). All patients admitted between 1 May 2011 and 31 August 2014 undergoing SOT were included in the retrospective study. The primary outcomes included a description of the association of enteric colonization and invasive infections by CP-Kp with one-year mortality. Secondary outcomes were the study of risk factors for colonization and invasive infections by CP-Kp. Results: A total of 5.4% (45/828) of SOT recipients had at least one positive rectal swab for CP-Kp, with most (88.9%) occurring after transplantation. 4.5% (35/828) of patients developed a CP-Kp-related invasive infection, with 68.6% (24/35) being previously colonized. The 1-year mortality was 31.1% in patients with enteric colonization with CP-Kp and, it was 51.4% among patients with CP-Kp-related invasive infections. At univariate analysis, colonization, invasive infections, sepsis, severe sepsis, and septic shock were significantly associated with 1-year mortality. At multivariate analysis, only invasive infections and the combination of sepsis, severe sepsis, or septic shock were significantly associated with 1-year mortality, whereas gastrointestinal colonization was significantly associated with survival. In this population, the 1-year mortality was significantly associated with invasive infections; otherwise, gastrointestinal colonization was not associated with increased 1-year mortality.

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Successful treatment of septic shock due to NDM-1-producing Klebsiella pneumoniae using ceftazidime/avibactam combined with aztreonam in solid organ transplant recipients: report of two cases

International Journal of Antimicrobial Agents ◽

10.1016/j.ijantimicag.2019.10.023 ◽

2020 ◽

Vol 55 (1) ◽

pp. 105842 ◽

Cited By ~ 5

Author(s):

Laura Benchetrit ◽

Vincent Mathy ◽

Laurence Armand-Lefevre ◽

Lila Bouadma ◽

Jean-François Timsit

Keyword(s):

Septic Shock ◽

Klebsiella Pneumoniae ◽

Successful Treatment ◽

Organ Transplant ◽

Solid Organ Transplant ◽

Solid Organ ◽

Transplant Recipients ◽

Organ Transplant Recipients ◽

Solid Organ Transplant Recipients

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Trimethoprim/sulfamethoxazole for nocardiosis in solid organ transplant recipients: real‐life data from a multicentre retrospective study

Transplant Infectious Disease ◽

10.1111/tid.13669 ◽

2021 ◽

Author(s):

Pierre‐Louis Conan ◽

Marie Matignon ◽

Alexandre Bleibtreu ◽

Hélène Guillot ◽

Steven Van Laecke ◽

...

Keyword(s):

Retrospective Study ◽

Organ Transplant ◽

Real Life ◽

Solid Organ Transplant ◽

Solid Organ ◽

Transplant Recipients ◽

Life Data ◽

Real Life Data ◽

Solid Organ Transplant Recipients ◽

Multicentre Retrospective Study

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Ribavirin for Hepatitis E Virus Infection After Organ Transplantation: A Large European Retrospective Multicenter Study

Clinical Infectious Diseases ◽

10.1093/cid/ciz953 ◽

2019 ◽

Vol 71 (5) ◽

pp. 1204-1211 ◽

Cited By ~ 13

Author(s):

Nassim Kamar ◽

Florence Abravanel ◽

Patrick Behrendt ◽

Jörg Hofmann ◽

Georges Phillippe Pageaux ◽

...

Keyword(s):

Chronic Hepatitis ◽

Retrospective Study ◽

Multicenter Study ◽

Virological Response ◽

Hepatitis E Virus ◽

Large Scale ◽

Organ Transplant ◽

Hepatitis E ◽

Solid Organ Transplant ◽

Solid Organ

Abstract Background Ribavirin is currently recommended for treating chronic hepatitis E virus (HEV) infection. This retrospective European multicenter study aimed to assess the sustained virological response (SVR) in a large cohort of solid organ transplant (SOT) recipients with chronic HEV infection treated with ribavirin monotherapy (N = 255), to identify the predictive factors for SVR, and to evaluate the impact of HEV RNA mutations on virological response. Methods Data from 255 SOT recipients with chronic HEV infection from 30 European centers were analyzed. Ribavirin was given at the median dose of 600 (range, 29–1200) mg/day (mean, 8.6 ± 3.6 mg/kg/day) for a median duration of 3 (range, 0.25–18) months. Results After a first course of ribavirin, the SVR rate was 81.2%. It increased to 89.8% when some patients were offered a second course of ribavirin. An increased lymphocyte count at the initiation of therapy was a predictive factor for SVR, while poor hematological tolerance of ribavirin requiring its dose reduction (28%) and blood transfusion (15.7%) were associated with more relapse after ribavirin cessation. Pretreatment HEV polymerase mutations and de novo mutations under ribavirin did not have a negative impact on HEV clearance. Anemia was the main adverse event. Conclusions This large-scale retrospective study confirms that ribavirin is highly efficient for treating chronic HEV infection in SOT recipients and shows that the predominant HEV RNA polymerase mutations found in this study do not affect the rate of HEV clearance. This large-scale retrospective study that included 255 solid organ transplant recipients confirms that ribavirin is highly efficient for treating chronic hepatitis E virus (HEV) infection and shows that HEV RNA polymerase mutations do not play a role in HEV clearance.

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1744. CMV Infection and Management Among Pediatric Solid-Organ Transplant Recipients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1607 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S639-S639

Author(s):

Anna Sharova ◽

Despoina M Galetaki ◽

Molly Hayes ◽

Lauren Gianchetti ◽

Laura A Vella ◽

...

Keyword(s):

Organ Transplant ◽

Solid Organ Transplant ◽

First Year ◽

Invasive Infection ◽

Solid Organ ◽

Cmv Infection ◽

Research Support ◽

Free Survival ◽

Medium Risk ◽

Cmv Disease

Abstract Background Our institution provides universal CMV prophylaxis (PPX) for all high (D+/R-) and medium risk (R+) solid-organ transplant (SOT) recipients. We sought to evaluate this practice by assessing CMV infection and disease within the first year of SOT. Methods Retrospective cohort study of all children undergoing first SOT at Children’s Hospital of Philadelphia from January 2012 to October 2017. We identified recipients with CMV infection (detection of CMV DNA in body fluid/tissue with or without symptoms) and disease (symptomatic or tissue-invasive infection) in the first year after SOT. We calculated the rate of CMV infection and compared CMV-free survival based on SOT type and CMV risk using log-rank tests. Results 244 children received 246 SOTs: 90 liver, 70 kidney, 59 heart, 27 lung. In total, 39 children (16%) had 49 CMV infections in the first year after SOT, including 29% of high (n = 21/72) and 23% of medium risk recipients (n = 16/69). The fraction of each organ type with CMV infection was similar (Figure 1, P = 0.33). Among high and medium risk recipients, all of whom received PPX, the incidence rate of CMV infection in the first year post-SOT was similar: 10.1 vs. 7.8/10,000 days (P = 0.22). There were no differences in CMV-free survival by organ (Figure 2, log-rank P = 0.25) or between high and medium risk recipients (Figure 3, log-rank P = 0.46). In total, 22% (n = 10/45) of CMV infections in high/medium risk patients occurred while on PPX; half were in the setting of reduced PPX dosing or within 2 weeks of SOT. Of the 35 CMV infections post-PPX, the median time to detection of CMV after PPX was 39 days (IQR 28–98). There were 11 cases (6 high, 5 medium risk) of CMV disease: 6 CMV syndrome, 2 hepatitis, 2 pneumonitis, 1 GI disease. Valganciclovir was more often used for treatment of asymptomatic infections than for CMV disease (79% vs. 33%, P = 0.03). All-cause mortality in the first year post-SOT was similar among those with and without CMV infections (7.7 vs. 6.3%, P = 0.76) and among those with and without CMV disease (9.1 vs. 5.2%, P = 0.57). Conclusion CMV infection was common in high and medium risk SOT recipients in the first year following SOT, and most infections occurred off of PPX. Our data suggest that the highest risk period for CMV infection is in the first months after PPX, and that monitoring may be most useful after PPX has been stopped or when PPX doses are reduced. Disclosures Kevin J. Downes, MD, Merck: Grant/Research Support, Research Grant; Pfizer: Grant/Research Support.

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