High Mortality Associated With Acinetobacter Species Infection in Liver Transplant Patients

Kim, Y.J.; Yoon, Jin‐Kook; Kim, S.I.; Hong, Kyung-Soon; Kim, J.I.; Choi, Jung‐Hyun; Yoon, Seung Kew; You, Yong‐Ouk; Lee, M.D.; Moon, In Sung; Kim, D.G.; Kang, Moon Won

doi:10.1016/j.transproceed.2011.06.011

Cited by 60 publications

(45 citation statements)

References 8 publications

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“…2) were Gammaproteobacteria such as Klebsiella pneumoniae, Acinetobacter sp. OT408, which is a close phylogenetic relative of Acinetobacter baumannii, and Pseudomonas fluorescens, all of which are frequently associated with extraoral infections in immunocompromised patients (4,27,28). The periodontal pathogen Treponema denticola was also more frequently found in the transplant population, although both groups did not differ in terms of their periodontal health (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Previous studies that evaluated the oral microflora in organ recipients suffered from the limitations of using a cultivation approach, which allowed identification of only a small number of species, and were confounded by the effects of antibiotics on the microflora of the studied subjects (31,32). Using high-throughput sequencing of 16S rRNA gene libraries, we found that pharmacological immunosuppression aimed at increasing allograft tolerance does not affect the most common and abundant bacterial species in saliva but increases the frequency of detection of microorganisms known to be the cause of extraoral infections in transplant recipients (4,27,30). Oral colonization by Gram-negative rods such as Klebsiella pneumoniae, Pseudomonas aeruginosa, Pseudomonas fluorescens, and Acinetobacter baumannii and by Gram-positive cocci such as Staphylococcus aureus and Enterococcus faecalis has been previously noted in other medically compromised subjects, particularly in bed-ridden elderly individuals (33).…”

Section: Discussionmentioning

confidence: 99%

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Transplantation-Associated Long-Term Immunosuppression Promotes Oral Colonization by Potentially Opportunistic Pathogens without Impacting Other Members of the Salivary Bacteriome

Diaz

Hong

Frias-Lopez³

et al. 2013

Clin Vaccine Immunol

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e Solid-organ transplant recipients rely on pharmacological immunosuppression to prevent allograft rejection. The effect of such chronic immunosuppression on the microflora at mucosal surfaces is not known. We evaluated the salivary bacterial microbiome of 20 transplant recipients and 19 nonimmunosuppressed controls via 454 pyrosequencing of 16S rRNA gene amplicons. Alpha-diversity and global community structure did not differ between transplant and control subjects. However, principal coordinate analysis showed differences in community membership. Taxa more prevalent in transplant subjects included operational taxonomic units (OTUs) of potentially opportunistic Gammaproteobacteria such as Klebsiella pneumoniae, Pseudomonas fluorescens, Acinetobacter species, Vibrio species, Enterobacteriaceae species, and the genera Acinetobacter and Klebsiella. Transplant subjects also had increased proportions of Pseudomonas aeruginosa, Acinetobacter species, Enterobacteriaceae species, and Enterococcus faecalis, among other OTUs, while genera with increased proportions included Klebsiella, Acinetobacter, Staphylococcus, and Enterococcus. Furthermore, in transplant subjects, the dose of the immunosuppressant prednisone positively correlated with bacterial richness, while prednisone and mycophenolate mofetil doses positively correlated with the prevalence and proportions of transplant-associated taxa. Correlation network analysis of OTU relative abundance revealed a cluster containing potentially opportunistic pathogens as transplant associated. This cluster positively correlated with serum levels of C-reactive protein, suggesting a link between the resident flora at mucosal compartments and systemic inflammation. Network connectivity analysis revealed opportunistic pathogens as highly connected to each other and to common oral commensals, pointing to bacterial interactions that may influence colonization. This work demonstrates that immunosuppression aimed at limiting Tcell-mediated responses creates a more permissive oral environment for potentially opportunistic pathogens without affecting other members of the salivary bacteriome.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Transplantation-Associated Long-Term Immunosuppression Promotes Oral Colonization by Potentially Opportunistic Pathogens without Impacting Other Members of the Salivary Bacteriome

Diaz

Hong

Frias-Lopez³

et al. 2013

Clin Vaccine Immunol

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“…Carbapenems have been used extensively before the outbreak of hospital infection. [14] Possibly, the resistant bacteria are dominant while the sensitive strains are eradicated because of wide use of highly effective broad-spectrum antimicrobial drugs. Judicious use of carbapenem with antibiotics stewardship programs would be the most effective measure to avoid the emergence of MDRAb and the associated unfavorable outcome.…”

Section: Discussionmentioning

confidence: 99%

Risk factors and antibiotic resistance of pneumonia caused by multidrug resistant Acinetobacter baumannii in pediatric intensive care unit

Cai¹,

Sun²,

Bao³

et al. 2012

World Journal of Emergency Medicine

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“…(8) Although the most often cited primary site of CRAB infection is the respiratory tract, some studies have shown that the abdominal cavity is the most common primary site of such infections among LT recipients. (6,7,9,10) Although there have been a number of case series investigating CRAB infection among LT recipients, the risk factors for CRAB colonization and infection after LT remain poorly defined in the literature. In addition, certain important aspects, such as the impact that pretransplant CRAB colonization or infection has on the incidence of posttransplant CRAB infection and survival among LT recipients, have not been evaluated.…”

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confidence: 99%

Carbapenem‐resistant A cinetobacter baumannii acquired before liver transplantation: Impact on recipient outcomes

et al. 2016

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Infection with carbapenem-resistant Acinetobacter baumannii (CRAB) after liver transplantation (LT) is associated with high mortality. This study aimed to identify risk factors for post-LT CRAB infection, as well as to evaluate the impact of pre-LT CRAB acquisition on the incidence of post-LT CRAB infection. This was a prospective cohort study of all patients undergoing LT at our facility between October 2009 and October 2011. Surveillance cultures (SCs) were collected immediately before LT and weekly thereafter, until discharge. We analyzed 196 patients who were submitted to 222 LTs. CRAB was identified in 105 (53.6%); 24 (22.9%) of these patients were found to have acquired CRAB before LT, and 85 (81.0%) tested positive on SCs. Post-LT CRAB infection occurred in 56 (28.6%), the most common site being the surgical wound. Multivariate analysis showed that the risk factors for developing CRAB infection were prolonged cold ischemia, post-LT dialysis, LT due to fulminant hepatitis, and pre-LT CRAB acquisition with pre-LT CRAB acquisition showing a considerable trend toward significance (P = 0.06). Among the recipients with CRAB infection, 60-day mortality was 46.4%, significantly higher than among those without (P < 0.001). Mortality risk factors were post-LT infection with multidrug-resistant bacteria, LT performed because of fulminant hepatitis, retransplantation, prolonged cold ischemia, longer LT surgical time, and pre-LT CRAB acquisition, the last showing a trend toward significance (P = 0.08). In conclusion, pre-LT CRAB acquisition appears to increase the risk of post-LT CRAB infection, which has a negative impact on recipient survival. Liver Transplantation 22 615-626 2016 AASLD.

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High Mortality Associated With Acinetobacter Species Infection in Liver Transplant Patients

Cited by 60 publications

References 8 publications

Transplantation-Associated Long-Term Immunosuppression Promotes Oral Colonization by Potentially Opportunistic Pathogens without Impacting Other Members of the Salivary Bacteriome

Transplantation-Associated Long-Term Immunosuppression Promotes Oral Colonization by Potentially Opportunistic Pathogens without Impacting Other Members of the Salivary Bacteriome

Risk factors and antibiotic resistance of pneumonia caused by multidrug resistant Acinetobacter baumannii in pediatric intensive care unit

Carbapenem‐resistant A cinetobacter baumannii acquired before liver transplantation: Impact on recipient outcomes

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