Early infection is a recognised complication after lung transplantation in patients with cystic fibrosis (CF). Our centre uses multiple combination bactericidal testing (MCBT) when determining appropriate peritransplant prophylactic regimens. To evaluate our strategy, we compared the incidence of posttransplant infection in patients whose peritransplant antimicrobial regimens were determined using MCBT versus standard sensitivity testing.
Patients with CF who were infected with Pseudomonas aeruginosa and underwent lung transplantations between 2000 and 2010 were included. Data was collected from clinical records and our microbiology database. Microorganisms cultured were mapped against antibiotic resistance, method of sensitivity testing, and antibiotics administered peritransplant.
129 patients were identified (mean age 28, male : female, 63 : 66). Fifty patients (38.8%) had antibiotics determined by MCBT. Two patients in the MCBT group developed septicaemia, 13 in the conventional group (P ≤ 0.05, 2-tailed Fisher's test). Sepsis was attributable to P. aeruginosa in one patient from the MCBT group and seven patients in the conventional group (P = 0.15). P. aeruginosa was recovered from the posttransplant pleural fluid of one patient who received MCBT-guided prophylaxis, six patients in the conventional group (P = 0.25). Patients given antibiotics based on MCBT had significantly lower rates of septicaemia and lower rates of empyema.
Purpose: Lung transplantation for cystic fibrosis (CF) patients colonised with pan resistant bacteria, in particular M abscessus complex (MABSC) may preclude them from lung transplantation due to poor outcomes. Treatment of MABSC generally consists of a 3 drug regime including nephrotoxic/ototoxic amikacin. Oral cysteamine is licenced for treatment of cystinosis and has recently been reported as having good antimicrobial, anti-biofilm and mucolytic activity against CF pathogens. We evaluated the antimicrobial activity of this compound against a collection of 31 strains of CF and non-CF pathogens including isolates from lung transplant recipients. We also evaluated the interaction of cysteamine with 12 anti-pseudomonal agents against 4 strains P aeruginosa (Pa). Methods: Microdilution MIC's against 12 MABSC were performed and bactericidal activity was assessed by subculture. MIC's were performed against a collection of 19 further strains including: Pa (n= 3), Achromobacter spp. (n= 2) and 1 each of the following: Burkholderia multivorans, Burkholderia cenocepacia, Ralstonia mannitolylitica, Pandoraea sp. Stenotrophomonas maltophilia, and Inquilinus limosus. NCTC strains of E coli, S aureus; C albicans, E faecalis and 4 carbapenemase-producing Enterobacteriacae (CPE) were also evaluated. The Multiple Combination Bactericidal Test (MCBT) was utilised to assess synergy by incorporating cysteamine at 500 mg/L with 12 agents at the systemic concentration. The 4 strains selected were only susceptible to colomycin. Results: Cysteamine at 500 mg/L was bactericidal against all 4 strains of Pa and no antagonism was observed with antipseudomonal agents. The MIC's of 12 MABSC were 256-1024 mg/L with bactericidal activity against 9 strains at 1024 mg/L and 512 mg/L for 2 strains. One strain was inhibited at 256 mg/L but no bactericidal activity observed at 1024 mg/L. The MIC's of the 19 other isolates ranged from 64-1024 mg/L with bactericidal activity ranging from 128-1024 mg/L for all except C albicans. Conclusion: The results of this study demonstrate that cysteamine has potential as an antimicrobial for the treatment of severe infection caused by pan resistant bacteria in lung transplant patients with or without CF and warrants further evaluation.
Introduction. It is estimated up to 6 % of prosthetic vascular grafts become infected. Staphylococcus aureus is predominant in early infection and coagulase-negative staphylococci are predominant in late infections. Enterobacteriaceae cause 14–40 % of prosthetic vascular graft infections. This is, to our knowledge the first reported case of Salmonella gastroenteritis causing chronic prosthetic vascular graft infection (PVGI).Case presentation. A 57 years old lady presented with signs and symptoms of prosthetic vascular graft infection. Three years earlier, she had undergone a prosthetic axillo-femoral bypass graft for critical limb ischaemia. The infected prosthetic vascular graft was removed and Salmonella Typhimurium was isolated on culture. In the intervening period, Salmonella Typhimurium was isolated from a faecal specimen, collected during an episode of acute gastroenteritis. Whole-genome sequencing (WGS) showed that the respective Salmonella Typhimurium isolates differed by only a single nucleotide polymorphism (SNP). Salmonella Typhimurium was not isolated on culture of a faecal specimen collected five days following cessation of antimicrobial therapy. Six months after removal of the prosthetic graft, the patient remains under follow-up for her peripheral vascular disease, which currently requires no further surgical intervention.Conclusion. This case has clear implications for the management of chronic PVGI. It is vital to collect high-quality surgical specimens for microbiological analysis and empirical choices of antibiotics are unlikely to cover all potential pathogens. It may also be prudent to enquire about a history of acute gastroenteritis when assessing patients presenting with chronic PVGI.
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