Course of transplant recipients treated with Ertapenem in the prophylaxis and treatment of infections: a first experience

Goegele, Hannes; Berger, Natalie; Kafka, Reinhold; Wenisch, Christoph; Tabarelli, Dominique; Tabarelli, Walther; Aranda-Michel, Jaime; Margreiter, Raimund; Bonatti, Hugo

doi:10.1007/s10353-007-0326-4

Cited by 3 publications

(2 citation statements)

References 30 publications

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“…Additionally, two studies were included after reference search of the abovementioned studies. Finally, 39 studies met the present study’s inclusion criteria [ 6 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ]. Additional information was kindly provided by the corresponding authors of two studies [ 40 , 48 ].…”

Section: Resultsmentioning

confidence: 99%

Endocarditis in Liver Transplant Recipients: A Systematic Review

Ιωάννου

Alexakis

Kofteridis

2021

JCM

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Infective Endocarditis (IE) is associated with significant mortality. Interestingly, IE in patients with liver transplantation has not been adequately described. The aim of this review was to systematically review all published cases of IE in liver transplant recipients and describe their epidemiology, microbiology, clinical characteristics, treatment and outcomes. A systematic review of PubMed, Scopus and Cochrane Library (through 2nd January 2021) for studies providing epidemiological, clinical, microbiological, treatment data and outcomes of IE in liver transplant recipients was conducted. A total of 39 studies, containing data for 62 patients, were included in the analysis. The most common causative pathogens were gram-positive microorganisms in 69.4%, fungi in 25.8%, and gram-negative microorganisms in 9.7% of cases, while in 9.3% IE was culture-negative. The aortic valve was the most commonly infected valve followed by mitral, tricuspid and the pulmonary valve. Aminoglycosides, vancomycin and aminopenicillins were the most commonly used antimicrobials, and surgical management was performed in half of the cases. Clinical cure was noted in 57.4%, while overall mortality was 43.5%. To conclude, this systematic review thoroughly describes IE in liver transplant recipients and provides information on epidemiology, clinical presentation, treatment and outcomes.

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Section: Resultsmentioning

confidence: 99%

Endocarditis in Liver Transplant Recipients: A Systematic Review

Ιωάννου

Alexakis

Kofteridis

2021

JCM

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“…Once E. corrodens, P. melaninogenica, and Lactobacillus spp. were isolated, treatment was changed to ertapenem (1 g daily), a carbapenem that is suitable for the treatment of susceptible mixed aerobeanaerobic surgical infections [36][37][38][39]. Thus far no data are available on therapy of liver abscesses with ertapenem; however, other carbapenems have been shown to be suitable agents [40].…”

Section: Discussionmentioning

confidence: 99%

Liver abscess due to Eikenella corrodens, Prevotella meloninogenica, and Lactobacillus spp. following pancreatoduodenectomy: Case report and review of the literature

et al. 2010

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Leberabszess durch Eikenella corrodens, Prevotella meloninogenica und Lactobacillus spp.Zusammenfassung. Grundlagen: Leberabszesse sind seltene Komplikationen bei Patienten, welche sich einer Pankreatektomie unterziehen. Eikenella corrodens ist ein Gram-negatives Stäbchen, welches bei Patienten mit Sepsis und Endokarditis isoliert wurde.Methodik: Wir berichten über einen Patienten, welcher 3 Monate nach Pankreatektomie und Polychemotherapie einen Leberabszess entwickelte. Drei untypische Erreger wurden nach Abszessdrainage isoliert. Bislang in der Literatur beschriebene Fälle von Leberabszessen mit Beteiligung dieser seltenen Erreger wurden zusammengefasst.Ergebnisse: Der 8 cm große Leberabszess wurde erfolgreich perkutan drainiert und Eikenella corrodens, Prevotella melaninogenica, and Lactobacillus spp. wurden aus dem Punktat isoliert. Die antibiotische Therapie umfasste initial Piperazillin=Tazobactam gefolgt von Ertapenem, und es kam innerhalb von 4 Wochen zur vollstän-digen Abheilung der schweren Infektion. Der Großteil bislang in der Literatur beschriebener Leberabszesse mit Beteiligung dieser Erreger wurde mittels perkutaner Drainge und gezielter antibiotischer Therapie erfolgreich behandelt. Eikenella corrodens (n ¼ 10) and Prevotella (n ¼ 8) wurden typischerweise bei polymikrobiellen Infektionen isoliert, während Lactobacillus (n ¼ 6) Leberabszesse häufig monomikrobiell waren.Schlussfolgerungen: Patienten, welche sich einer Pankreasresektion unterziehen und eine Chemotherapie erhalten, haben ein erhöhtes Infektionsrisiko. Seltene Krankheitsbilder wie Leberabszesse und seltene Erreger wie Eikenella corrodens sollten differentialdiagnostisch in Erwägung gezogen werden. Bei entsprechend frühzei-tiger Erkennung und adäquater Behandlung können diese Komplikationen durchaus erfolgreich behandelt werden.Schlüsselwörter: Leberabszess, Pankreaskarzinom, Pankreasresektion, Eikenella corrodens.Summary. Background: Liver abscess may be a complication after pancreatectomy. Eikenella corrodens is a rare pathogen associated with sepsis and endocarditis among other infections.Methods: We report on a patient who developed a polymicrobial liver abscess with three unusual pathogens three months following pylorus preserving pancreatoduodenectomy and adjuvant chemotherapy for pancreatic adenocarcinoma. A review of the literature with regard to liver abscesses caused by the rare pathogens was performed.Results: The eight cm pyogenic liver abscess, which grew Eikenella corrodens, Prevotella melaninogenica, and Lactobacillus spp., was successfully treated with percutaneous drainage and antibiotic therapy using piperacillin=tazobactam followed by ertapenem. Literature review for previously reported cases of liver abscesses due to these organisms revealed that most were percutaneously drained and had good outcome. Eikenella corrodens (n ¼ 10) and Prevotella (n ¼ 8) liver abscesses were typically polymicrobial, whereas Lactobacillus (n ¼ 6) liver abscesses were more commonly monomicrobial.

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Fatal endocarditis due to extended spectrum betalactamase producing Klebsiella terrigena in a liver transplant recipient

Goegele¹,

Ruttmann²,

Aranda-Michel³

et al. 2007

Wien Klin Wochenschr

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Fatal endocarditis due to extended spectrum betalactamase producing Klebsiella terrigena in a liver transplant recipientSir,We would like to report a case of infective endocarditis (IE) due to extended spectrum betalactamase (ESBL) producing Klebsiella terrigena. Klebsiella terrigena is a rarely encountered Gram negative rod and many microbiological laboratories still do not subtype Klebsiella to the species level. This is only the third reported case of IE due to ESBL producing Klebsiella, the second case in an adult and the first case in an organ recipient. Zimhony et al. reported on successful conservative therapy in an immuncompetent patient. However, in the immunocompromised host, a different management including surgery maybe is required [1]. Transplant recipient are at high risk for IE but still many cases are discovered at an advanced stage or post mortem [2][3][4][5][6][7][8][9][10][11][12]. In a series of 666 liver transplants performed during a 15 year period at our institution, we identified five patients with post mortem diagnosed IE. Fever, lassitude, and signs of inflammation can be absent in transplant recipients with infections and also can be present during acute rejection or other conditions of graft dysfunction.Our patient was a 45 year-old comatose, severe malnourished man with acute renal failure who underwent liver transplantation (LT) for chronic hepatitis C. The intraoperative course was unremarkable and transesophageal echocardiography for hemodynamic monitoring found all valves normal. Initial graft function was excellent. Perioperative prophylaxis included piperacillin/tazobactam, ciprofloxacin, vancomycin and liposomal amphotericin B. Sputum, throat swab and urine prior to LT grew ESBL producing Klebsiella and piperacillin/tazobactam was continued for 10 days, as the pathogen was reported to be sensitive. Immunosuppressive therapy included IL-2 receptor antagonist, mycophenolate-mofetil and steroids; tacrolimus was initiated on day 9 post LT (trough levels of 4-8 ng/ml). On day 24 he developed fever, and ertapenem (1 g daily) was added as Klebsiella was cultured from bronchial secretions. Subsequently the patient defervescenced. On day 48 post LT pneumonia was diagnosed on CT-scan. Empirical treatment included azithromycin, teicoplanin and meropenem with initial response. He clinically deteriorated and required ventilation. Multi-resistant coagulase negative staphylococci (MRCNS) were isolated from sputum and vancomycin was started, which was later changed to linezolid. Immunosuppression was tapered but the infection did not improve and graft dysfunction with cholestasis developed. Liver biopsy showed findings compatible with sepsis, however, mild rejection could not be ruled out. Graft function further worsened and bolused steroids were given without success. Immunosuppression was changed to low dose sirolimus (trough levels of < 5 ng/ml) monotherapy. On day 90 blood cultures became positive for MRCNS and vancomycin was again administered. Klebsiella spp. was isolated from sputum and...

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Course of transplant recipients treated with Ertapenem in the prophylaxis and treatment of infections: a first experience

Cited by 3 publications

References 30 publications

Endocarditis in Liver Transplant Recipients: A Systematic Review

Endocarditis in Liver Transplant Recipients: A Systematic Review

Liver abscess due to Eikenella corrodens, Prevotella meloninogenica, and Lactobacillus spp. following pancreatoduodenectomy: Case report and review of the literature

Fatal endocarditis due to extended spectrum betalactamase producing Klebsiella terrigena in a liver transplant recipient

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