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He KD, Naqvi SS, Cowan VL, Stack CM, Alonso CD, Blair BM. Epidemiology and outcomes associated with enterococcal blood stream infection among liver and kidney transplant recipients. Clin Transplant 2024; 38:e15285. [PMID: 38516923 DOI: 10.1111/ctr.15285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/31/2024] [Accepted: 02/24/2024] [Indexed: 03/23/2024]
Abstract
Bloodstream infections (BSIs) account for 18% of bacterial infections in the first year after solid organ transplantation (SOT). Enterococcus accounts for up to 20% of BSIs in this population, with vancomycin-resistant enterococcus (VRE) posing a particular risk. This is a retrospective, case-control study of adult liver and kidney transplant recipients between 01/01/2016 and 06/30/2021 that characterizes the epidemiology and outcomes of enterococcal BSIs in liver and kidney transplantations at a single institution. Subjects with an enterococcal BSI within the first 6 months post-transplant were compared to those with non-enterococcal BSIs in the same period. We identified 26 subjects with enterococcal BSIs and 28 controls with non-enterococcal BSIs (n = 54; 10.3%). Cases were mostly liver transplant recipients (n = 20; 77%) with a median MELD at transplant of 33 (range 14-43); controls included 14 KT recipients (50%). Groups differed significantly (all p < .05) by factors including perioperative transfusion requirements, need for reoperation, and number of interventions post-transplant. Cases had a median time of 25.5 days to infection and controls 100.5 days (p < .0001). There were no differences in 1-year mortality between the groups. Enterococcus faecium was the predominant species of Enterococcus (n = 23; 88.5%), with a majority (91.3%) of the isolates being VRE. In our liver and kidney transplants, enterococcal BSIs occurred early among liver transplant recipients. The high incidence of VRE among E. faecium isolates in this population warrants further investigation into the optimal approach to empiric antimicrobials for bacteremia in the early post-transplant period.
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Affiliation(s)
- Kevin D He
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Syed Suhaib Naqvi
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Vanessa L Cowan
- Harvard Medical School, Boston, Massachusetts, USA
- Transplant Institute, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Conor M Stack
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Carolyn D Alonso
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Barbra M Blair
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Wu X, Cao G, Wang Z, Wu X, Tian X, Gu Y, Shao F, Yan T. Antibiotic ampicillin induces immune tolerance in renal transplantation by regulating the proportion of intestinal flora in mice. Front Cell Infect Microbiol 2022; 12:1048076. [DOI: 10.3389/fcimb.2022.1048076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/27/2022] [Indexed: 11/19/2022] Open
Abstract
ObjectivesThere are significant differences in the composition of intestinal flora in renal transplant recipients before and after an operation, which has a great impact on the prognosis of renal transplantation. The purpose of this project is to study the effect of intestinal flora imbalance on renal transplantation.MethodsThe animal model of renal transplantation was established after intestinal flora imbalance (mice pretreated with compound antibiotics), or the animal model of renal transplantation was established after being pretreated with single antibiotics. HE, PAS, and Masson staining was used to detecting the histopathological changes of transplanted renal. The expression of inflammatory factors and infiltration of inflammatory cells of renal tissue were respectively been detected by ELISA kit and flow cytometry.ResultsAntibiotic pretreatment restored weight loss, and decreased serum creatinine level in mice after renal transplantation. The tissue staining, ELISA assay, and flow cytometry data showed that antibiotic pretreatment alleviated injury of the renal allograft, inhibited the inflammatory factors levels, and reduced inflammatory cell infiltration in mice after renal transplantation. Furthermore, single antibiotic, especially ampicillin pretreatment can also play the same role as compound antibiotics, such as restoring weight loss, decreasing serum creatinine level, alleviating renal allograft injury, inhibiting inflammatory factors levels, and reducing inflammatory cell infiltration in mice after renal transplantation.ConclusionsAntibiotic ampicillin may inhibit inflammatory cell infiltration after renal transplantation by regulating the proportion of intestinal flora in mice, to reduce renal injury and play a role in renal protection.
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Tholany J, Kobayashi T, Marra AR, Schweizer ML, Samuelson RJ, Suzuki H. Impact of infectious diseases consultation on the outcome of patients with enterococcal bacteremia: a systematic literature review and meta-analysis. Open Forum Infect Dis 2022; 9:ofac200. [PMID: 35794948 PMCID: PMC9251672 DOI: 10.1093/ofid/ofac200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/07/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Enterococcal bacteremia carries significant mortality. While multiple studies have evaluated the impact of infectious disease consultation (IDC) on this condition, these studies were limited by the low numbers of patients enrolled. This systemic literature review and meta-analysis were conducted to determine whether IDC was associated with a mortality benefit among patients with enterococcal bacteremia.
Methods
We performed a systematic literature search using 5 databases for studies evaluating IDC among patients with enterococcal bacteremia. We conducted a meta-analysis to assess whether IDC was associated with reduced mortality. Random-effect models were used to calculated pooled odds ratios (pORs). Heterogeneity was evaluated using I2 estimation and the Cochrane Q statistic test.
Results
The systemic literature review revealed 6496 reports, from which 18 studies were evaluated in the systemic literature review and 16 studies in the meta-analysis. When all studies were pooled, the association between IDC and mortality was not statistically significant with a pOR of 0.81 (95% CI, 0.61-1.08) and there was substantial heterogeneity (I2=58%). When the studies were limited to those reporting multivariate analysis including IDC, there was a significant protective effect of IDC (pOR=0.40; 95% CI, 0.24-0.68) without heterogeneity (I2=0%). Some studies also showed additional benefits to IDC, including appropriate antibiotic therapy, and improved diagnostic use.
Conclusions
IDC was associated with 60% lower odds of mortality when patients were well-matched, potentially through improvement in the care for patients with enterococcal bacteremia. IDC should be considered a part of routine care for patients with enterococcal bacteremia.
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Affiliation(s)
- Joseph Tholany
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
| | - Takaaki Kobayashi
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
| | - Alexandre R Marra
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, United States
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marin L Schweizer
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, United States
| | - Riley J Samuelson
- Hardin Library for the Health Sciences, University of Iowa Libraries, Iowa City, Iowa, United States
| | - Hiroyuki Suzuki
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, United States
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