Transplant Infectious Disease最新文献

{"title":"Invasive Fungal Diseases in Patients With Multiple Myeloma: Experience at a Large, Urban Referral Center.","authors":"Emily Baneman, Alan Weinberg, Timothy Sullivan, Risa Fuller, Dallas Dunn, Sarah Taimur, Meenakshi Rana, Samantha E Jacobs","doi":"10.1111/tid.14439","DOIUrl":"10.1111/tid.14439","url":null,"abstract":"<p><strong>Background: </strong>Although infections are a leading cause of morbidity and mortality among patients with multiple myeloma (MM), the epidemiology of invasive fungal disease (IFD) is less well characterized in this population than in other hematologic malignancies.</p><p><strong>Methods: </strong>We conducted a nested 3:1 case-control study of IFD at a large MM referral center to identify risk factors for IFD in this population.</p><p><strong>Results: </strong>In a cohort of 2960 patients, we identified 32 episodes of IFD among 31 patients between 01/2011 and 06/2019. There was a median of 3.6 years from MM diagnosis to IFD, and patients had a median of four lines of chemotherapy (range 1-12) before IFD. Seventeen (53%) had previous autologous hematopoietic cell transplants. At the time of IFD, 23 (72%) had progressive disease status. Fifteen (47%) and 13 (41%) had severe neutropenia and lymphopenia, respectively, and 18 (56%) had hypogammaglobulinemia. Microbiologic etiologies included Aspergillus (n = 18), Candida (n = 6), Cryptococcus (n = 3), Mucorales (n = 3), Histoplasma (n = 1), and undetermined organism (n = 1). In the case-control analysis, progressive disease status (OR 1.35, p = 0.02) and neutropenia (OR 17.5, p = 0.02) were significant risk factors for IFD. In addition, ≥3 prior lines of chemotherapy trended toward statistical significance (OR 5.6, p = 0.07).</p><p><strong>Conclusion: </strong>This is the largest detailed description of IFD epidemiology in MM patients and the largest controlled analysis of risk factors in this population. Overall, the risk of IFD was low.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e14439"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persisting Gaps in Cytomegalovirus Prevention and Management After Solid Organ Transplantation in a Resource-Limited Setting.","authors":"Guilherme Santoro-Lopes, Luiz Felipe Abreu Guimarães, Wanessa Trindade Clemente, Raquel Silveira Bello Stucchi, Edson Abdala, Daniel Wagner de Castro Lima Santos, Gustavo Fernandes Ferreira, Luciana Bertocco Paiva Haddad, Ligia Camera Pierrotti","doi":"10.1111/tid.14440","DOIUrl":"10.1111/tid.14440","url":null,"abstract":"<p><strong>Background: </strong>Cytomegalovirus (CMV) infection remains among the leading complications after solid organ transplantation (SOT). Large international surveys mainly focused on high-income countries, detected considerable variability in the management of this infection after SOT. Limited data are available from resource-limited settings.</p><p><strong>Methods: </strong>A questionnaire-based cross-sectional study was performed. All transplant programs (TP) registered at the Brazilian Organ Transplantation Society (ABTO) were invited to participate.</p><p><strong>Results: </strong>Sixty-one TP participated in the study. Of these, 59 (97%) reported using at least 1 preventive strategy (prophylaxis or preemptive therapy [PET]). Prophylaxis was reported by only 39 (64%). PET was used by 52 (85%), predominantly for R+ recipients (n = 42/61; 70%). CMV monitoring was performed weekly in only 22 of 52 (42%) TP. This was significantly more common in TP reporting turnaround times ≤72 h for quantitative nuclear acid amplification tests (p < 0.001). Intravenous (IV) ganciclovir was the predominant drug chosen for prophylaxis (21/39 TP; 54%) and for PET (44/52 TP; 77%). Lack of regular access to valganciclovir was significantly associated with the choice of IV ganciclovir for prophylaxis and PET (p = 0.002 for both comparisons). Only 8 (13%) TP had access to molecular diagnostic tests for ganciclovir resistance, and 14 (23%) had access to effective therapy for highly resistant infections.</p><p><strong>Conclusion: </strong>These results suggest that strategies to improve the management of CMV after SOT in such a resource-limited setting are needed and should include not only targeted educational programs but also initiatives to tackle economic and structural barriers.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e14440"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infections Management in the Lung Transplant Setting in Italy: A Web-Survey.","authors":"Andrea Lombardi, Paolo Grossi, Malgorzata Mikulska, Maddalena Giannella, Renato Pascale, Serena Marinello, Francesca Montagnani, Elena Seminari, Silvia Corcione, Alessandra Bandera, Alessandro Bertani, Alessandra Mularoni","doi":"10.1111/tid.14413","DOIUrl":"10.1111/tid.14413","url":null,"abstract":"<p><strong>Introduction: </strong>Infections significantly impact morbidity and mortality in lung transplant (LuTx) recipients. This survey focused on documenting current practices regarding the prevention and management of infections in LuTx in Italy.</p><p><strong>Methods: </strong>A 52-question survey was administered online in the period from December 1, 2023, to January 31, 2024, assessing center characteristics, Tx team organization, microbiological investigations, infection prevention, and management. All Italian LuTx centers were invited to participate.</p><p><strong>Results: </strong>Nine out of 10 Italian LuTx centers answered. Most centers (6/9, 67%) performed LuTx only on adults. Chronic infection or colonization by Mycobacterium abscessus and Burkholderia cenocepacia is considered a contraindication to LuTx in five and two centers, respectively. For cytomegalovirus D+/R- patients, prophylaxis is used in six centers (67%), with a variable duration from 3 to 12 months. Two centers also use IgG. Three centers (33%) use a pre-emptive strategy. Four centers (45%) screen for Human herpesvirus 8 infection. Regarding antibiotic prophylaxis, most centers (6/9, 67%) utilise a dual regimen of anti-pseudomonal penicillin plus glycopeptide. The two most common durations of antibiotic prophylaxis were 72 h and 7 days, each reported by two centers (22%). Targeted prophylaxis against fungal infections is employed by a minority of centers (4/9, 44%). Inhaled amphotericin B is the most common antifungal, used as targeted prophylaxis (2/4, 50%) and universal prophylaxis (2/5, 40%). Almost all centers (8/9, 89%) involve the Tx infectious diseases specialist in the recipient management since the pre-listing period.</p><p><strong>Conclusion: </strong>There is considerable heterogeneity in infection management among Italian LuTx centers. Establishing a shared platform for data collection and outcome evaluation is essential to improve infection management.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e14413"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12017298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Don't Wait for the Storm-Fix the Roof While the Sun Shines! Lessons for Ensuring Safe Transplantation in Patients at Risk for Chagas Disease.","authors":"Laura Barcán, Marcelo Radisic","doi":"10.1111/tid.70028","DOIUrl":"10.1111/tid.70028","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70028"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carbapenemase-Producing Enterobacterales: An Increasing Threat to Australian Liver Transplant Recipients.","authors":"Dinuli Kamaladasa, Ken Liu, Leanne Dolan, Sebastiaan J van Hal, Andie Lee, Tina Marinelli","doi":"10.1111/tid.14432","DOIUrl":"10.1111/tid.14432","url":null,"abstract":"<p><strong>Introduction: </strong>Carbapenemase-producing Enterobacterales (CPE) are associated with increased morbidity and mortality in liver transplant recipients (LTRs). There is a paucity of data regarding CPE colonization and infection in Australian LTRs.</p><p><strong>Methods: </strong>A single-center retrospective cohort study of CPE was performed in LTRs from 2015 to 2024. LTRs underwent targeted screening and a period of enhanced screening to evaluate the incidence of CPE colonization. CPE infections were identified via clinical samples. All CPE isolates underwent whole genome sequencing. CPE isolation rates in LTRs were compared to the general hospital population and trends over time were analyzed.</p><p><strong>Results: </strong>There were 31 episodes of CPE isolation (5 community acquired, 26 healthcare associated) from 28 LTRs. Nine episodes of CPE infection were found: urinary tract (n = 3), bloodstream (n = 3), wound/abscess (n = 2), and Salmonella gastroenteritis (n = 1). The remaining 22 episodes represented new CPE colonization. CPE Klebsiella pneumoniae was the most common bacterial species (n = 12) with the New Delhi metallo-β-lactamase (n = 13), the most common CPE gene detected. CPE isolation rates in LTRs increased over the study period (p = 0.06). The overall rate of CPE infection was significantly higher in LTRs than the general hospital population (1.92 vs. 0.30 per 10 000 occupied bed days, p = 0.04). Enhanced CPE screening identified an additional eight episodes of CPE colonization in 415 patients screened (1.9%).</p><p><strong>Conclusion: </strong>CPE is an emerging threat for Australian LTRs and there is an urgent need to optimize strategies to prevent CPE colonization and infection in LTRs.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e14432"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12017315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disseminated Histoplasmosis Manifesting as Oral Lesions in a Kidney Transplant Patient.","authors":"Sebastian Hinojosa, Kaitlyn Reasoner, Trey Richardson, Levan Gakhokidze, Alissa Ice, Mozibur Rahman, Richard W LaRue, Heidi Schaefer, Anthony Langone","doi":"10.1111/tid.70018","DOIUrl":"10.1111/tid.70018","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70018"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship Between Body Weight and Leukopenia in Non-Kidney Solid Organ Transplant Recipients With Normal Renal Function Who Are Receiving Valganciclovir for CMV Prophylaxis.","authors":"Sara Haddad, Kevin Dee, Augusto Dulanto Chiang, Fionna Feller, Tan Ding, Gregory D Ayers, Marissa Potts, Richard W LaRue","doi":"10.1111/tid.14418","DOIUrl":"10.1111/tid.14418","url":null,"abstract":"<p><strong>Background: </strong>Cytomegalovirus (CMV) disease causes significant morbidity among solid organ transplant (SOT) recipients. To prevent CMV disease, eligible recipients are frequently started on valganciclovir (VGC) prophylaxis post-transplant. Leukopenia has been documented as a primary adverse events of the drug (1). This study's primary aim was to determine whether a patient's weight at the start of VGC prophylaxis was associated with the development of leukopenia.</p><p><strong>Methods: </strong>This was a single center, retrospective cohort study that included adults > 18 years of age, who had received an organ transplant (heart, liver, or lung) at an academic transplant center from January 1, 2018 through December 31, 2022. A creatinine clearance of > 60 mL/min was required.</p><p><strong>Results: </strong>All 294 included patients received 900 mg/day of VGC for CMV prophylaxis, without dose adjustment. Fifty-two percent of the patients developed leukopenia while receiving VGC prophylaxis. The mean weight at initiation of VGC was higher in patients who did not develop leukopenia (97.9 kg) compared to those who did (90.7 kg; p = 0.0112). It was found that with each 1 kg increase in body weight, the likelihood of developing leukopenia decreased by 1.7% (p = 0.004, odds ratio = 0.983, 95% confidence interval [CI], 0.972-0.994). Patients with a baseline body-mass index (BMI) > 25 had a longer median freedom time from leukopenia after initiation of VGC as compared to the group with baseline BMI < 25 (log-rank p = 0.035).</p><p><strong>Conclusion: </strong>These data suggest that in SOT recipients with normal renal function, receiving a fixed dose of VGC resulted in a significant, inverse relationship between body weight and the development of leukopenia.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e14418"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12017309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Swiss Transplant Cohort Study: Implications for Transplant Infectious Diseases Research.","authors":"Christian van Delden, Oriol Manuel, Cédric Hirzel, Laura N Walti, Nina Khanna, Hans H Hirsch, Neofytos Dionyios, Philipp Kohler, Irene A Abela, Nicolas J Mueller","doi":"10.1111/tid.70023","DOIUrl":"10.1111/tid.70023","url":null,"abstract":"<p><p>The longitudinal, nationwide Swiss Transplant Cohort Study (STCS) follows > 92% of all transplant recipients with comprehensive data collection tailored to overall and organ-specific transplant outcomes. Transplant infectious disease events are assembled under the auspices of transplant ID specialists using common definitions. With over 6000 active patients and a median follow-up exceeding 6 years, the cohort offers a unique platform for understanding real-world epidemiology in transplanted patients. Beyond observational analysis, the STCS supports randomized controlled trials to address specific research questions. This overview highlights the achievements of the STCS and explores its future directions.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70023"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing the Rising Burden of Carbapenemase-Producing Enterobacterales in Liver Transplant Recipients: A Call for Enhanced Surveillance and Prevention Strategies.","authors":"Muna A Al-Maslamani, Javed Iqbal","doi":"10.1111/tid.70014","DOIUrl":"10.1111/tid.70014","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70014"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduction in Length of Hospital Stays for Allogeneic Hematopoietic Stem-Cell Transplantation in the Letermovir Era.","authors":"Hiroki Hosoi, Misato Tane, Tadashi Okamura, Shotaro Tabata, Ke Wan, Shogo Murata, Toshiki Mushino, Akinori Nishikawa, Takashi Sonoki","doi":"10.1111/tid.70008","DOIUrl":"10.1111/tid.70008","url":null,"abstract":"<p><strong>Background: </strong>In recent years, letermovir has been routinely used for cytomegalovirus (CMV) infection prophylaxis in patients receiving allogeneic hematopoietic stem-cell transplantation (HSCT). The reduction effect of letermovir on CMV infection rates and the impact on survival have been studied, but other potential benefits of letermovir remain underexplored.</p><p><strong>Methods: </strong>This retrospective study included patients who underwent first-time allogeneic HSCT between October 2013 and August 2023. We compared the length of hospital stay between eras before and after the introduction of letermovir (\"nonletermovir group\" and \"letermovir group,\" respectively). Secondary outcomes included clinically significant CMV infection rates and hospitalization costs.</p><p><strong>Results: </strong>A total of 59 patients were analyzed in the nonletermovir group and 65 patients in the letermovir group. The median length of hospital stay was 51 days in the nonletermovir group and 42 days in the letermovir group (p < 0.001). Among standard-risk disease patients, the letermovir group also had significantly shorter hospital stays (p = 0.0048). Additionally, the cumulative incidence of clinically significant CMV infection and grade II-IV acute graft-versus-host disease were both lower in the letermovir group. Hospitalization costs were not significantly different between the two groups.</p><p><strong>Conclusion: </strong>The length of hospital stays after HSCT was observed to be shorter following the introduction of letermovir in this study. This reduction in hospital stays did not decrease hospitalization costs in relation to allogeneic HSCT, but it may alleviate the burden on both patients and healthcare providers.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70008"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}