Antimicrobial strategies in the care of organ transplant recipients

Abstract

Since the early days of transplantation, infection has been a major consequence of antirejection immunosuppressive therapy. Increasingly effective prophylactic and preemptive strategies are being developed to prevent the infectious consequences of immunosuppressive therapy. Although the data base is incomplete and there remains a compelling need for well-designed, randomized, comparative trials, the potential for controlling life-threatening viral, bacterial, fungal, and protozoal infections exists. The cornerstone of this effort is the recognition that effective immunosuppressive strategies require an antimicrobial program to make them safe and that such an antimicrobial program needs to be individualized in order to be appropriately matched with the needs of the antirejection program. Thus, escalation and de-escalation of the antimicrobial program should be carried out to match the immunosuppressive program. Infection and rejection remain closely intertwined, linked by the immunosuppressive program that is prescribed.

Bacterial Infections after Renal Transplantation

“…Therefore, the incidence varies between 0.2% [41] and 56% [33]. Mortality rates of 30% have been attributed to wound infections.…”

“…as well as uropathogens (e.g. E. coli) [19,41], Wound infections often need surgical intervention and prolonged hospitali zation [37], Dangerous situations occur when the infec tion is located in the perirenal space in the iliac fossa, which may cause anastomotic rupture [43] due to gram negative rods. Staphylococcus aureus or fungi.…”

Evisceration of the Eye in a Renal Transplant Recipient with Cytomegalovirus Chorioretinitis

“…two or three times daily for 3 weeks, is generally effective for chorioretinitis. The most com mon side effect is leukopenia [4], Even with ganciclovir treatment, blindness in one or both eyes is the most important complica tion [2]. Although severe endophthalmitis requiring enucleation was described in renal transplant recipients [5], bacterial endoph thalmitis and periorbital cellulitis associated with CMV chorioretinitis necessitating evis ceration were not reported before.…”

A follow up study of cytomegalovirus infection in a group of Turkish renal transplant recipients using molecular assays

“…After six months, they were 80, 66.7, 80, 66.7 for CMV PCR and 73.3, 88.9, 91.7, 66.7% Human cytomegalovirus (CMV) infection is responsible for significant mortality and morbidity and graft failure in renal transplant recipients (Tong et al 1998). The early identification of CMV is important as the majority of patients develop infection and the best result is obtained when treatment is started earlier (Rubin & Tolkoff-Rubin 1993). CMV must be detected before clinical symptom appearance, but virus detection is not always followed by CMV disease (Eckart et al 1997).…”

“…The early identification of CMV is important as the majority of patients develop infection and the best result is obtained when treatment is started earlier (Rubin & Tolkoff-Rubin 1993). CMV must be detected before clinical symptom appearance, but virus detection is not always followed by CMV disease (Eckart et al 1997).…”