Bloodstream infections after solid-organ transplantation

Abstract

Solid-organ transplantation (SOT) has become the preferred strategy to treat a number of end-stage organ disease, because a continuous improvement in survival and quality of life. While preventive strategies has decreased the risk for classical opportunistic infections (such as viral, fungal and parasite infections), bacterial infections, and particularly bloodstream infections (BSIs) remain the most common and life-threatening complications in SOT recipients. The source of BSI after transplant depends on the type of transplantation, being urinary tract infection, pneumonia, and intraabdominal infections the most common infections occurring after kidney, lung and liver transplantation, respectively. The risk for candidemia is higher in abdominal-organ than in thoracic-organ transplantation. Currently, the increasing prevalence of multi-drug resistant (MDR) Gram-negative pathogens, such as extended-spectrum betalactamase-producing Enterobacteriaciae and carbapenem-resistant Klebsiella pneumoniae, is causing particular concerns in SOT recipients, a population which presents several risk factors for developing infections due to MDR organisms. The application of strict preventive policies to reduce the incidence of post transplant BSIs and to control the spread of MDR organisms, including the implementation of specific stewardship programs to avoid the overuse of antibiotics and antifungal drugs, are essential steps to reduce the impact of post transplant infections on allograft and patient outcomes.

Epidemiology and impact of bloodstream infections among kidney transplant recipients: A retrospective single‐center experience

“…The trend was higher in later studies, though our study (2009‐2016) showed less frequent ESBL‐producing E. coli (12.7%) and Klebsiella (29.2%) than reported in the Greek experience (2010‐2013): 2/6 (33.3%) for E. coli and 2/5 (40%) for Klebsiella . These findings signify the increasing risk for RTR to develop infection by multidrug‐resistant pathogens …”

“…Our data confirm that amoxicillin‐clavulanic acid and ciprofloxacin are not appropriate choices in BSI of urinary origin. The high rate of cotrimoxazole resistance may reflect its use in prophylaxis against Pneumocystis pneumonia and UTIs in the early post‐transplant period …”

Beta-lactam and quinolone resistance markers in uropathogenic strains isolated from renal transplant recipients

“…Phenotypic and molecular characterization of the clinical isolates revealed that 22 (73.33%) were ESBL producers, i.e. : K. pneumoniae (14), P. aeruginosa (4), M. morganii (2), E. coli (1) and E. tarda (1). The findings of our study are in accordance with several other studies that are describing an elevated frequency of ESBL infections among RTRs that received prophylactic antibiotic treatment [20,21,4,22,23].…”

“…Additionally, the widespread use of antibiotics employed for prophylaxis and treatment of transplant recipients is leading to an increasing resistance to antibiotics among uropathogenic isolates [1,2]. Different studies reported that infections caused by beta-lactam resistant-K. pneumoniae in kidney transplant recipients were associated with higher mortality [3], recurrent UTIs being also reported [4,5].…”

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“…Solid-organ transplant (SOT) recipients have a higher risk of developing infectious and noninfectious pulmonary diseases due to their immunocom promised state. 1 The incidence of pulmonary infections is, however, decreasing owing to the use of prophylactic regimens and the adjustment of immunosuppressive medications; however, pulmo nary infections remain largely responsible for mortality and morbidity among SOT recipients. 2 In this study, we analyzed the incidence of pulmonary disorders in SOT recipients and outcomes in these patients.…”