Concern has been raised regarding the response to vaccination in solid organ transplant recipients (SOTR) undergoing immunosuppressant regimens and the possibility of rejection related to the immune response associated with pandemic influenza H1N1-2009 vaccination. The goal of this study was to assess the immunogenicity, efficacy and safety of the pandemic vaccine in SOTR. We performed a multicenter prospective study in SOTR receiving the pandemic vaccine. Immunological response was determined in serum 5 weeks after vaccination by microneutralization assays, and immunoglobulins were measured by ELISA. Three hundred and forty-six SOTR were included. Preexisting seroprotection was detected in 13.6% of cases and rates of seroconversion and seroprotection after vaccination were 73.1% and 82.9%, respectively. Patients with baseline antibody titers had better geometric mean titers (GMT)-post after pandemic vaccination (339.4 vs. 121.4, p < 0.001). Younger age, liver disease and m-TOR inhibitor therapy were independently associated with lower seroprotection and GMT-post. There were no major adverse effects or rejection episodes.Pandemic vaccine was safe in SOTR and elicited an adequate response, although lower than in healthy individuals. This is the first study describing a decreased response after vaccination in patients receiving mTOR inhibitors who presented lower seroprotection rates and lower GMT-post.

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A real-time PCR assay was developed for detecting the presence of Acinetobacter baumannii on hospital equipment and compared to conventional bacterial culture using 100 hospital environmental samples. The real-time PCR detected contaminated surfaces in 4 h with high sensitivity (100%) compared to conventional culture. Thirty-eight percent of samples were positive by real-time PCR and negative by bacterial culture (false positives), possibly indicating the widespread presence of bacterial DNA that is not associated with viable bacteria. N osocomial infections caused by drug-resistant bacteria represent an important clinical challenge. Acinetobacter baumannii has become one of the most problematic causative agents of nosocomial infections due to its remarkable ability to survive on hospital surfaces and acquire antibiotic resistance, resulting in the global emergence of multidrug-resistant strains with resistance to multiple antibiotic classes (5). A. baumannii has been especially problematic in critically ill patients in the intensive care setting, as it is an important cause of ventilator-associated pneumonia and bacteremia. In this context, patients are exposed to A. baumannii via contact with contaminated hospital equipment or by contact with hospital personnel carrying the bacteria. A number of studies have demonstrated widespread contamination with A. baumannii on hospital environmental surfaces, most notably in intensive care units (ICUs) (1,4,8,9).Environmental surveillance protocols have been employed for the identification of hospital equipment colonized by A. baumannii so that appropriate decontamination procedures can be carried out (1,4,8,9). Since these surveillance methods employ conventional bacterial culture to determine the presence of A. baumannii, definitive species identification can require between 24 and 48 h. Nucleic acid-based tests, such as real-time PCR, have been employed for the identification of numerous bacterial pathogens (2); however, to our knowledge this technique has not been applied to identifying contaminated hospital equipment. The objective of the present study was to develop a real-time PCR for identifying hospital surfaces colonized by A. baumannii.A real-time PCR assay was developed using TaqMan chemistry for the amplification of nucleotides 774 to 859 of the outer membrane protein A gene (ompA; accession number AY485227). The ompA gene was chosen because it is present in all sequenced genomes of A. baumannii available in the public domain (as of March 2010), and the sequences chosen for the primers and probe correspond to regions highly conserved between published A. baumannii ompA sequences (100% sequence identity). The primers OmpA Forward (5=-TCTTGGTGGTCACTTGAAGC-3=) and Ompa Reverse (5=-ACTCTTGTGGTTGTGGAGCA-3=) and the probe (5=-AAGTTGCTCCAGTTGAACCAACTCCA-3=), 5= labeled with 6-carboxyfluorescein and the 3= labeled with 6-carboxytetramethylrhodamine, were used. A quantification standard, pGEM-ompA, was constructed by inserting the ompA gene from the ATCC 19606 strain...

Whether influenza vaccination influences the severity of illness in cases of clinical failure in solid organ transplant (SOT) recipients receiving influenza vaccine has not been extensively studied. Our goal was to evaluate the frequency of influenza vaccination among SOT recipients with influenza disease and its impact on the illness severity during the 2010-2011 season. Adult SOT recipients with confirmed influenza infection were included from December 2010 to April 2011. Follow-up data were recorded and antibody titres were determined using a microneutralization assay. Sixty-four SOT recipients were included in the study, ten (15.6%) with severe disease, requiring admission to intensive care units, of whom four (6.3%) died. In all, 34 (53.1%) received the 2010-2011 seasonal influenza vaccine and 32 (50.0%) received the 2009-H1N1 pandemic vaccine, and none had detectable antibodies against influenza at the time of diagnosis of influenza infection. Twenty-three (67.6%) of the patients that received the vaccine required hospital admission and presented less dyspnoea (10, 29.4% versus 14 (50.0%), p 0.09) and pneumonia (8, 23.8% versus 15, 50.0%, p 0.03, relative risk 0.3, 95% CI 0.1-0.9) than unvaccinated patients, with relative risk reductions of 60% and 70%, respectively. Although influenza vaccination confers protection on SOT recipients against developing influenza pneumonia, the rate of clinical failure is still high. New strategies to improve influenza immunization are needed for this group of patients.

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