Intra‐abdominal infections among adult intestinal and multivisceral transplant recipients in the 2‐year post‐operative period

Abstract

Background Intestinal and multivisceral transplantations are treatment options for patients with intestinal failure. Transplantation is often complicated by abdominal and/or bloodstream infections in the post‐operative period. Methods A retrospective chart review of all adults who underwent intestinal or multivisceral transplantation at our institution from 2003 to 2015 was performed. Data were collected for 2 years post transplant. Results A total of 106 intestinal or multivisceral transplants were performed in 103 patients. The median age at the time of transplant was 44 (IQR: 34‐52) with 55% (n = 58) male and 45% (n = 48) female. There were 46 (43%) intra‐abdominal infections post transplant among the 103 patients, and six transplant recipients (13%) developed concurrent bloodstream infections. The median time to first intra‐abdominal infection was 23 days (IQR: 10‐48). For those with organisms isolated in culture, forty‐seven percent of the isolates were gram negative, 39% gram positive, 7% anaerobes, and 7% yeast. The most common isolates were enterococci at 28%, E. coli at 14%, and Klebsiella spp at 13%. Sixty‐three percent of the enterococci were vancomycin‐resistant enterococci (VRE), and 22% of the gram‐negative isolates were extended spectrum beta‐lactamases (ESBLs). Patients with intra‐abdominal infections had longer hospital post‐transplant length of stays at a median of 35 days (IQR: 25‐48) vs 23 days (IQR: 17‐33) for those without infections, P = .0012. There was no difference in all‐cause mortality in patients with or without intra‐abdominal infections, P = .654. Conclusions Intra‐abdominal infections are common in intestinal or multivisceral transplant recipients, but despite this complication, we found no increased risk of mortality. These transplant recipients are also at risk for infection with drug‐resistant organisms.

Clonal distribution of vancomycin‐resistant Enterococcus faecium in Turkey and the new singleton ST733

“…The source of these isolates was as follows: majority of isolates obtained from blood 84.5% (n = 39), urine (n = 21), 15.5% from surgical wound specimens (n=3), 3 cerebrospinal fluid (n=2), abscess (n=2), 2 bronchoalveolar lavage (n=1), 1 catheter tube (n=2), 2 and transtracheal fluid samples (n=1), respectively.…”

“…Long period of hospitalization in the intensive care, transplant, hematology, or oncology units, receiving hemodialysis, contact with patients diagnosed with VRE, enteral feeding, corticosteroid use, administration of antineoplastic treatment, sucralfate use, and the history of the use of antibiotic (vancomycin, second-or third-generation cephalosporins, metronidazole, clindamycin, imipenem, ticarcillin-clavulanic acid) were reported as the risk factors. [1][2][3][4][5] Allogenic bone marrow transplant, neutropenia, use of central venous line, and hypoalbuminemia were described as the independent risk factors in the development of the VRE bacteremia in the multi-variant analyses. [6][7][8][9] Although seven different resistance genotypes ( pear to be more deadly and more costly than infections caused by vancomycin-susceptible strains, epidemiological data concerning occurrence and spread of these microorganisms have to be compiled, and VRE isolates have to be epidemiologically investigated.…”

“…Various risk factors which significantly contributed to the invasive VRE infections and caused mortality were described before. Long period of hospitalization in the intensive care, transplant, hematology, or oncology units, receiving hemodialysis, contact with patients diagnosed with VRE, enteral feeding, corticosteroid use, administration of antineoplastic treatment, sucralfate use, and the history of the use of antibiotic (vancomycin, second‐ or third‐generation cephalosporins, metronidazole, clindamycin, imipenem, ticarcillin‐clavulanic acid) were reported as the risk factors 1‐5 . Allogenic bone marrow transplant, neutropenia, use of central venous line, and hypoalbuminemia were described as the independent risk factors in the development of the VRE bacteremia in the multi‐variant analyses 6‐9 …”

“…differences were analyzed. Interestingly, isolates (strain numbers2,3,5,8,12,13,15,21,22,27,28,33,34, and 43) with differently related PFGE patterns had the same ST (ST16). This indicates that PFGE is more discriminatory than MLST for homology analysis of small areas in the short term, such as the examination of hospital or ward isolates.…”

Bloodstream infections among intestinal and multivisceral transplant recipients

“…8 Similar to liver transplant recipients, patients who undergo intestinal or multivisceral transplantation have complex abdominal surgeries and are at risk for intra-abdominal infections. 7 However, intestinal and multivisceral transplant recipients are unique in that they often have poor venous access requiring prolonged central venous catheters or develop post-transplant delayed graft function, intestinal obstructions, or other indications that require continued parenteral nutrition in the early post-transplant period. 5 Additionally, intestinal allografts have large amounts of lymphoid tissue and a high bacterial load, and immunosuppression must be balanced between the risk of both rejection and infection.…”