Transplant Infectious Disease最新文献

{"title":"Recurrent Outbreak of Carbapenem-Resistant IMP-1-Producing Pseudomonas aeruginosa in Kidney Transplant Recipients: The Impact of Prolonged Patient Colonization.","authors":"Maristela P Freire, Carlos Henrique Camargo, Laina Bubach, Amanda Yaeko Yamada, Fernanda Spadão, Carolina Andrade Lopes, Claudio Tavares Sacchi, Karoline Rodrigues Campos, Marlon Benedito Nascimento Santos, Jose Otto Reusing Junior, Ana Paula Cury, Flavia Rossi, Evangelina da Motta P A de Araujo, Anna Sara Levin, William Carlos Nahas, Elias David-Neto, Ligia C Pierrotti","doi":"10.1111/tid.14414","DOIUrl":"10.1111/tid.14414","url":null,"abstract":"<p><strong>Background: </strong>Infections by carbapenem-resistant Pseudomonas aeruginosa (CRPA) have been associated with high morbidity and mortality among solid organ recipients.</p><p><strong>Objectives: </strong>To delineate the epidemiological and molecular characteristics of a recurrent outbreak of imipenem (IMP)-producing P. aeruginosa (CRPA) among kidney transplant (KT) recipient METHODS: We described a recurring CRPA outbreak in a KT ward, divided into two periods: before unit closure (Feb 2019-2020) and after reopening (Aug 2020-Dec 2023). Routine surveillance cultures (SCs) were performed using axillary-perineum-rectal swabs with immunochromatographic tests. A case-control study identified risk factors for CRPA acquisition. Pulsed-field gel electrophoresis and whole genome sequencing characterized the strains.</p><p><strong>Results: </strong>After reopening, new cases arose from patients previously colonized, peaking 18 months later. A total of 67 KT recipients with CRPA-IMP-producing strains were identified. All except one sequenced strain belonged to the ST446 clone, differing by a maximum of 110 single nucleotide polymorphisms. Forty-five (67.2%) cases were identified through SC, with 45.7% showing intermittent SC positivity. Patients remained colonized for up to 623 days. Twenty-four (35.8%) patients had infections, with the most common site being the urinary tract. Identified risk factors included older age, deceased donor, re-transplantation, reoperation, carbapenem or quinolone use, lymphopenia, hospital stay >10 days, and the first 60 days post-KT.</p><p><strong>Conclusion: </strong>KT recipients can harbor CRPA for extended periods, and detecting CRPA-colonized patients is challenging. These characteristics highlight the patient as the major source and a critical point in outbreak control.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e14414"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781153","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":"Acanthamoeba Infection in a Hematopoietic Cell Transplant Recipient: Challenges in Diagnosis, Management, and Source Identification.","authors":"Camellia T Banerjee, Sean Conlan, Anahita Mostaghim, Angela Michelin, Matthew Arduino, Mia Mattioli, Julia C Haston, Sanchita Das, Amir Seyedmousavi, Bickey H Chang, Elise M O'Connell, Christopher G Kanakry, Akbulut Dilara, Martha Quezado, Juan Gea-Banacloche, Clay Deming, Julia A Segre, Alison Han, Jennifer Cuellar-Rodriguez","doi":"10.1111/tid.14425","DOIUrl":"10.1111/tid.14425","url":null,"abstract":"<p><p>We report a case of Acanthamoeba infection in an HCT recipient with steroid-refractory GVHD. We highlight the multiple challenges that free-living ameba infections present to the clinician, the clinical laboratory, transplant infectious disease for review, hospital epidemiology if nosocomial transmission is considered, and public health officials, as exposure source identification can be a significant challenge. Transplant physicians should include Acanthamoeba infections in their differential diagnosis of a patient with skin, sinus, lung, and/or brain involvement.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e14425"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11827738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898179","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 Utility of Interferon-γ Release Assays in the Diagnosis of Tuberculosis in Patients With Cancer.","authors":"Marjorie V Batista, Joseph Sassine, Fareed Khawaja, Prathit A Kulkarni, Georgios Angelidakis, Joumana Kmeid, Firas El Chaer, Ella J Ariza-Heredia, Edward A Graviss, Victor E Mulanovich, Roy F Chemaly","doi":"10.1111/tid.14428","DOIUrl":"https://doi.org/10.1111/tid.14428","url":null,"abstract":"<p><strong>Background: </strong>Patients with cancer are at elevated risk for tuberculosis (TB) reactivation. Diagnosis of latent TB infection and TB disease remains challenging in this patient population despite the advent of interferon-γ release assays (IGRA).</p><p><strong>Methods: </strong>We retrospectively reviewed medical records of all patients with cancer who had IGRA testing (QuantiFERON-TB [QFT-TB] or T-SPOT.TB) at a major cancer center in the United States from June 2010 to July 2017. The results were analyzed with respect to the likelihood of latent TB infection and TB disease.</p><p><strong>Results: </strong>A total of 1299 patients were included with 1599 tests performed: 586 QFT-TB and 1013 T-SPOT.TB. Forty-nine (4%) patients were diagnosed with latent TB, and four (1%) with TB disease. T-SPOT.TB was more likely to yield an actionable result (positive or negative) than QFT-TB (89% vs. 65%, p < 0.001). The rate of indeterminate results for QFT-TB was higher than the rate of invalid results for T-SPOT.TB (35% and 10%, respectively, p < 0.001). On multivariate analysis, independent predictors of an invalid T-SPOT.TB included prior receipt of alemtuzumab, lower hemoglobin, absolute lymphocyte count, or serum albumin (p < 0.05 each), whereas the independent predictors of an indeterminate QFT-TB were female gender, prior receipt of systemic corticosteroids, and lower hemoglobin, or serum albumin or higher absolute neutrophil count (p < 0.05 each).</p><p><strong>Conclusions: </strong>T-SPOT.TB yielded more actionable results than QFT-TB in patients with cancer. T-SPOT.TB might be a better IGRA for screening for latent TB infection in patients with cancer, although a direct comparison would be needed to definitively determine this.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e14428"},"PeriodicalIF":2.6,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898342","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":"Outcomes Associated With Blastomycosis in Solid Organ and Hematopoietic Cell Transplant Recipients.","authors":"Vaisak O Nair, Bradley Johnson, Paschalis Vergidis, Nischal Ranganath","doi":"10.1111/tid.14430","DOIUrl":"https://doi.org/10.1111/tid.14430","url":null,"abstract":"<p><strong>Introduction: </strong>With reports of expanding epidemiology of blastomycosis across the United States, the purpose of this study was to evaluate the incidence and outcomes associated with blastomycosis in solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients.</p><p><strong>Methods: </strong>We conducted a retrospective case series of adult SOT and HCT recipients at a tertiary care medical center between January 1, 2005 and September 30, 2023. Cases were defined as culture-proven blastomycosis. We performed descriptive statistical analysis to evaluate diagnosis, management, and outcomes (mortality) of blastomycosis in SOT.</p><p><strong>Results: </strong>The cumulative incidence of blastomycosis was 0.11% with a median time to infection following transplant of 743 days. Of the 19 cases, the majority of patients were SOT recipients (90%). Supratherapeutic immunosuppression within 30 days of diagnosis was observed in 42% of cases with documented drug monitoring. Urine antigen testing was highly sensitive (100%). Fourteen (73.7%) patients received induction therapy with liposomal amphotericin B followed by azole therapy for a minimum of 12 months. Despite appropriate treatment, 1-year mortality was high at 26.3%, with attributable mortality of 21.1%.</p><p><strong>Conclusions: </strong>While rates of blastomycosis remain low among SOT and HCT recipients, infection is associated with poor posttransplant outcomes. Antigen testing can aid in timely assessment of disease severity and initiation of appropriate therapy. Among survivors, no relapses were observed while on lifelong secondary suppression. Future studies should aim to better define risk factors associated with developing blastomycosis and establish effective strategies for prevention.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e14430"},"PeriodicalIF":2.6,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898187","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":"Latent Tuberculosis Infection Amongst Allogeneic Hematopoietic Stem Cell Transplant Recipients: The Impact of Routine Pretransplant Review by a Transplant Infectious Diseases Physician.","authors":"Gabriel Paykin, Sara Vogrin, Peter Shuttleworth, Andrew Gador-Whyte, Sarah Garner, Janine Trevillyan, Eric Wong, Olivia Smibert","doi":"10.1111/tid.14429","DOIUrl":"https://doi.org/10.1111/tid.14429","url":null,"abstract":"<p><strong>Background: </strong>Identifying patients with latent tuberculosis infection (LTBI) is challenging. This is particularly true amongst immunocompromised hosts, in whom the diagnostic accuracy of available tests is limited. The authors evaluated the impact of routine pretransplant review by a transplant infectious diseases (TID) physician on LTBI screening in allogeneic hematopoietic stem cell transplant (alloHSCT) recipients.</p><p><strong>Methods: </strong>Adult patients who received an alloHSCT between January 2018 and December 2022 were eligible for inclusion. Data were retrospectively extracted from patient records. Participants were dichotomized into those that had a routine pretransplant review with a TID physician and who that did not.</p><p><strong>Results: </strong>Of the 116 participants included, 61.2% had a documented TID review. This intervention was associated with more frequent initiation of LTBI treatment (8.5% vs. 0.0%) and a tendency for LTBI treatment to be initiated in the absence of immunodiagnostic criteria (7.1% vs. 0.0%). A case of LTBI reactivation occurred in each group.</p><p><strong>Conclusion: </strong>Routine pretransplant review by TID physicians improved the recognition of risk factors for LTBI and increased the initiation of LTBI treatment in patients with a high pretest probability of LTBI. Further research is needed to evaluate the utility of routine pretransplant TID review and to determine the optimal strategy for preventing LTBI reactivation amongst alloHSCT recipients in low-endemic settings.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e14429"},"PeriodicalIF":2.6,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898199","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":"Successful Management of Refractory Cytomegalovirus Infection After Intestinal Transplantation Using Maribavir.","authors":"Hsi-Ming Liu, Ya-Hui Tsai, Yun Chen","doi":"10.1111/tid.14427","DOIUrl":"https://doi.org/10.1111/tid.14427","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e14427"},"PeriodicalIF":2.6,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898214","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":"https://doi.org/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":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe Outcomes of Pneumocystis Pneumonia: A 10-year Retrospective Cohort Study.","authors":"Poramed Winichakoon, Javier Tomas Solera Rallo, Hanan Albasata, Susan Marie Poutanen, Seyed M Hosseini-Moghaddam","doi":"10.1111/tid.14417","DOIUrl":"https://doi.org/10.1111/tid.14417","url":null,"abstract":"<p><strong>Background: </strong>A considerable knowledge gap exists in predicting severe Pneumocystis pneumonia (PCP) outcomes following PCP diagnosis.</p><p><strong>Methods: </strong>In this retrospective cohort, we studied immunocompromised patients with PCP admitted to 5 University Health Network centers in Canada (2011-2022). The study outcome included severe PCP, a composite of 21-day ICU admission or 28-day all-cause mortality. Adjusted odds ratios (aOR) estimated the association between severe PCP and comorbidities as well as clinical and laboratory variables at diagnosis.</p><p><strong>Results: </strong>A total of 44 out of 182 (24.2%) immunocompromised patients (19 [10.4%] HIV-infected, 55 [30.2%] hematologic malignancies, 32 [17.6%] hematopoietic stem cell transplants, 32 [17.6% solid tumors, 26 solid organ transplants [14.3%], 12 (6.6%) autoimmune diseases, and 6 (3.3%) other immunosuppressive conditions) developed composite outcomes (40 ICU admissions [21.9%], 18 deaths [9.9%]). Patients with composite outcomes more often had acute-onset PCP (< 7 days) (18/34 [52.9%] vs. 38/126 [30.1%], p = 0.013), shortness of breath (39/44 [88.6%] vs. 96/136 [70.6%], p = 0.002), chronic liver disease (15/44 [34.1%] vs. 9/138 [6.5%], p < 0.001), hypoalbuminemia (median [IQR] albumin (g/L): 27 [25-31] vs. 32 [29-35], p < 0.001), elevated lactate dehydrogenase (median [IQR] LDH (U/L): 537 [324-809] vs. 340 [237-475], p < 0.001), lymphopenia (median [IQR] absolute lymphocyte count [(10*9/L),]: 0.4 [0.2-0.6] vs. 0.7 [0.3-1.2], p < 0.001), or required supplemental oxygen (39/44 [88.6%] vs. 60/136 [44.1%], p < 0.001) than those without composite outcomes. In multivariable analysis, chronic liver disease (aOR: 11.6, 95% CI: 2.2-61.3) and requiring supplemental oxygen on admission (aOR: 19.7, 95% CI: 3.0-128.5) were significantly associated with severe PCP.</p><p><strong>Conclusions: </strong>Alongside hypoxemia upon admission, chronic liver disease appears to significantly predict severe PCP in immunocompromised patients. This biologically plausible finding warrants further investigation.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e14417"},"PeriodicalIF":2.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847761","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":"Disparities in Access to Valganciclovir Cytomegalovirus Prophylaxis in High-Risk African American Kidney Transplant Patients.","authors":"Shipra R Bethi, David J Taber, Erika Andrade, Zaid M Mesmar, Isabel Calimlim, Courtney E Harris","doi":"10.1111/tid.14416","DOIUrl":"https://doi.org/10.1111/tid.14416","url":null,"abstract":"<p><strong>Background: </strong>While access and outcomes disparities for African American (AA) kidney transplant recipients are documented, there are limited studies assessing medication access disparities in transplantation. Cytomegalovirus (CMV) causes severe complications for transplant recipients, and we aimed to understand differences in access to CMV prophylaxis valganciclovir and its impact on CMV infection rates in AA transplant recipients.</p><p><strong>Methods: </strong>This single-center, retrospective longitudinal cohort study examined high-risk (CMV serostatus D+/R-) adult kidney transplant recipients between June 1, 2010, and May 31, 202, through EMR abstraction. Standard univariate comparative statistics were employed alongside binary logistic regression for multivariable modeling.</p><p><strong>Results: </strong>During the 10 year period, 418 kidney transplant recipients were included, with 179 (42.8%) identified as AA and 239 as non-AA. There were significant differences in mean age (p = 0.001) and private versus Medicaid insurance status (p < 0.001). AAs experienced higher death-censored graft loss rates (10.6% AA vs. 5.0% non-AA, p = 0.031). CMV infection rate, opportunistic infection rate, leukopenia incidence, and death did not differ significantly between AA and non-AA patients. AA patients were 42% less likely to receive valganciclovir out-of-pocket cost assistance compared to non-AA patients (OR 0.58, [0.379-0.892], p = 0.013). When incorporating age, Medicaid status, and donor marginality in a multivariable model, the impact of AA race on utilizing assistance programs became statistically non-significant (OR 0.70, [0.448-1.094], p = 0.118).</p><p><strong>Conclusions: </strong>AAs were significantly less likely to leverage assistance programs or utilize personal resources to access valganciclovir. This disparity was partially explained by age, insurance status, and donor type. Despite this, CMV infection rates were similar between AA and non-AA cohorts.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e14416"},"PeriodicalIF":2.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847683","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":"The Journal in 2024: Reflections and Thanks for Our Reviewers: Thank You for 2024 Reviewers.","authors":"Michael G Ison","doi":"10.1111/tid.14423","DOIUrl":"https://doi.org/10.1111/tid.14423","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e14423"},"PeriodicalIF":2.6,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829689","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}