Spectrum of Pulmonary Infections in Renal Transplant Recipients in the Tropics: A Single Center Study

Efficacy and safety of carrimycin in ten patients with severe pneumonia following solid organ transplantation

BACKGROUND

The number of patients undergoing solid organ transplantation has increased annually. However, infections in solid organ transplant recipients can have a severe effect on patient survival owing to the continued use of immunosuppressants. Carrimycin is a novel macrolide antibiotic produced by genetically engineered streptomyces spiramyceticus harboring a 4''-O-isovaleryltransferase gene (ist) from streptomyces thermotoleran. Carrimycin has good antibacterial and antiviral effects. However, no relevant studies have been conducted on the efficacy and safety of carrimycin in patients with severe pneumonia (SP) after solid organ transplantation.

AIM

To explore the efficacy and safety of carrimycin in patients with SP after solid organ transplantation to provide a medication reference for clinical treatment.

METHODS

In March 2022, ten patients with SP following solid-organ transplantation were treated at our hospital between January 2021 and March 2022. When the condition was critical and difficult to control with other drugs, carrimycin was administered. These ten patients' clinical features and treatment protocols were retrospectively analyzed, and the efficacy and safety of carrimycin for treating SP following solid organ transplantation were evaluated.

RESULTS

All ten patients were included in the analysis. Regarding etiological agent detection, there were three cases of fungal pneumonia, two cases of bacterial pneumonia, two cases of Pneumocystis pneumonia, and three cases of mixed infections. After treatment with carrimycin, the disease in seven patients significantly improved, the course of the disease was significantly shortened, fever was quickly controlled, chest computed tomography was significantly improved, and oxygenation was significantly improved. Finally, the patients were discharged after curing. One patient died of acute respiratory distress syndrome, and two patients discontinued treatment.

CONCLUSION

Carrimycin is a safe and effective treatment modality for SP following solid organ transplantation. Carrimycin may have antibacterial and antiviral effects in patients with SP following solid organ transplantation.

Role of Fine Needle Aspiration Cytology in the Rapid Diagnosis of Pulmonary Infections in Renal Allograft Recipients with Respiratory Failure

Background

Renal transplantation is the treatment of choice in patients with end-stage renal disease. However, allograft recipients are at a higher risk of infection due to immunosuppressive therapies. This study aimed to analyze the utility of fine needle aspiration cytology (FNAC) lung in the etiological diagnosis of pulmonary infections in renal allograft recipients with respiratory failure.

Materials and Methods

This is a retrospective study done in post-renal transplant patients presenting with pulmonary infections and respiratory failure in the past 7 years, in whom image-guided lung FNAC was done for diagnosis.

Results

A total of 35 renal allograft recipients presenting with respiratory failure and having focal or diffuse pulmonary opacities (lesions) on radiological imaging were subjected to lung FNAC. The mean age of the patients was 41.1 ± 11.8 years (range 19-72), with the majority being males (n = 28, 80%); six (17.1%) of them were on invasive ventilation. The diagnostic yield of FNAC in our cohort was 77.1% (27 out of 35). Microorganisms were isolated in 21 cases (60%), with Nocardia being the most common (nine cases, 25.7%), Mycobacterial tuberculosis identified in six patients (17.1%), Aspergillus in three (8.6%), and one (2.9%) each had atypical Mycobacterium, zygomycetes, and Cryptococcus. FNAC suggested viral cytopathic effect in five patients, and cytomegalovirus (CMV) quantitative polymerase chain reaction test was found positive in four of these. One case was diagnosed as adenocarcinoma lung.

Conclusion

Lung FNAC is a useful for establishing the etiological diagnosis of pulmonary lesions in renal transplant patients with respiratory failure.

Pulmonary Complications in Renal Transplant Recipients

Background Kidney transplantation recipients are at an increased risk of lung complications due to infectious or non-infectious reasons. We aimed to determine the lung complications after transplantation and what we could do to prevent the complications during the follow-up, retrospectively. Material and Methods The 296 patients who underwent kidney transplantation surgery in our centre between the years 1999 to 2006 were included in the study. Results 75% of the patients were male (n: 222). 77% of the patients (n: 228) had a living-related donor. The mean hospitalisation duration in the post-transplantation period was 13.3±9.07 days. During the follow-up, 37.2% of the patients (n: 110) had rejection, and pulse steroid treatments were given to the 74.5% of these patients. In our study, the lung complication development ratio was 16.2%, and 84% of these complications were due to infections. A specific aetiology was not identified in 63.5% of patients. The patients with a living-related donor had more lung complications due to infection (p

Aetiology, management, and outcome of lower respiratory tract infection in renal allograft recipients - A report from a tropical country

Introduction

Lower respiratory tract infections (LRTIs) among renal transplant recipients (RTRs) are a significant cause of morbidity and mortality. This study aimed to analyse the aetiology, outcome, and risk factors associated with mortality.

Methods

We analysed baseline transplant characteristics, symptoms, hospital course, laboratory, serological and microbial results, and their association with the outcome of all RTRs between January 2011 and December 2019.

Results

A total of 206 LRTI patients out of 1051 RTRs were analysed. The incidence proportion was nearly 22 episodes per 1000 patients per year. The mean age was 39.3 years, with male predominance. Bacterial was the most common aetiology (53%), and staphylococcus was the most common species. Among the fungal causes (14%), 68% had aspergillus infection. More than one-third RTRs died during the hospital course mainly because of bacterial causes (42.6%). The aspergillus infection was the most common fungus associated with 50% mortality. On multi-variate analysis, sepsis, septic shock, and the need for mechanical ventilation independently predicted mortality.

Conclusion

Bacterial aetiology was the most common cause; though the fungal aetiology was seen less, it was associated with higher mortality. Mortality in RTR with LRTI was associated with sepsis, septic shock, and the need for mechanical ventilation.

Frequency of pre- and post-transplant infectious agents in kidney transplant patients

Purpose: Renal transplantation is the most important and successful treatment method for renal failure. In this study, it was aimed to investigate the frequency of Cytomegalovirus (CMV), BK virus (BKV) and bacterial agents in kidney transplant recipient (KTR)s before and in the first six months after transplantation. Materials and Methods: CMV and BKV were investigated by Real-time PCR in blood samples taken from patients who underwent kidney transplantation at the Organ Transplantation Center of our faculty, one week before the transplantation and in the first, third and sixth months after transplantation. Blood, urine, respiratory tract /wound (if necessary) cultures were performed. Decoy cells were evaluated in urine cytology. Results: The mean age of KTRs was 32.60±11.71 years, 28 (62.2%) were male. Donor origins were living related donors 39 (86.7%) and cadaveric 6 (13.3%). After transplantation, BKV was detected in 11/38 (28.9%) patients, CMV was found in 25/41 (60.9%) patients, and Decoy cell positivity was detected in 11/31 (35.4%) patients. While the highest rate of Real-time PCR positivities were in the third months and sixth months for BKV and first, month for CMV and gradually decreased towards the sixth month. Escherichia coli, Klebsiella pneumoniae, Candida nonalbicans, Enterococcus faecalis were most commonly grown in urine culture. Staphylococcus hominis, Streptecoccus epidermidis, were grown in blood culture. Acinetobacter baumannii, Klebsiella pneumoniae, Aspergillus fumigatus and Candida albicans grew in the culture of respiratory tract samples. Conclusion: Bacterial infections developed early in our KTRs. While the highest Real-time PCR positivity rate was in the third and sixth months for BKV, it was the first month for CMV and gradually decreased towards the sixth month. Decoy cell positivity may be also important for diagnosis of BKV infection in KTRs.

Chest X-ray and chest CT findings in patients diagnosed with pulmonary tuberculosis following solid organ transplantation: a systematic review

The objective of this systematic review was to select articles including chest X-ray or chest CT findings in patients who developed pulmonary tuberculosis following solid organ transplantation (lung, kidney, or liver). The following search terms were used: "tuberculosis"; "transplants"; "transplantation"; "mycobacterium"; and "lung". The databases used in this review were PubMed and the Brazilian Biblioteca Virtual em Saúde (Virtual Health Library). We selected articles in English, Portuguese, or Spanish, regardless of the year of publication, that met the selection criteria in their title, abstract, or body of text. Articles with no data on chest CT or chest X-ray findings were excluded, as were those not related to solid organ transplantation or pulmonary tuberculosis. We selected 29 articles involving a collective total of 219 patients. The largest samples were in studies conducted in Brazil and South Korea (78 and 35 patients, respectively). The imaging findings were subdivided into five common patterns. The imaging findings varied depending on the transplanted organ in these patients. In liver and lung transplant recipients, the most common pattern was the classic one for pulmonary tuberculosis (cavitation and "tree-in-bud" nodules), which is similar to the findings for pulmonary tuberculosis in the general population. The proportion of cases showing a miliary pattern and lymph node enlargement, which is most similar to the pattern seen in patients coinfected with tuberculosis and HIV, was highest among the kidney transplant recipients. Further studies evaluating clinical data, such as immunosuppression regimens, are needed in order to improve understanding of the distribution of these imaging patterns in this population.

Bacteria Isolated From Respiratory Tract Specimens of Renal Recipients With Acute Respiratory Distress Syndrome Due to Pneumonia: Epidemiology and Susceptibility of the Strains

OBJECTIVE

We estimated species distribution and frequency of antimicrobial resistance among bacterial pathogens isolated from respiratory tract specimens of renal recipients with acute respiratory distress syndrome (ARDS) due to pneumonia.

METHODS

We retrospectively collected patient demographics and clinical characteristics and microbiologic culture data with the use of standard microbiologic procedures and commercially available tests.

RESULTS

From January 2001 to August 2014, 320 respiratory tract specimens were obtained from 94 renal recipients with ARDS. Bacterial cultures were positive in 134 specimens from 68 recipients (72.3%), yielding 139 bacterial strains. The most commonly isolated species were gram-negative bacteria (111 isolates) with dominance of Acinetobacter baumanii (29.7%) and Pseudomonas aeruginosa (18.0%). The gram-negative bacteria were relatively resistant to 1st- and 2nd-generation cephalosporin and monocyclic beta-lactam and relatively sensitive to levofloxacin and meropenem, with rates of resistance of 80.2%, 76.6%, 73.9%, 36.0%, and 44.1%, respectively. The gram-positive bacteria, excluding Streptococcus uberis, were sensitive to glycopeptides and oxazolidone.

CONCLUSIONS

Gram-negative bacteria predominated as 79.9% of isolates from respiratory tract specimens of renal recipients with ARDS. The gram-negative bacteria were relatively sensitive to levofloxacin and meropenem and the gram-positive bacteria were sensitive to glycopeptides and oxazolidone.

Mortality predictors in recipients developing acute respiratory distress syndrome due to pneumonia after kidney transplantation

BACKGROUND

The aim of the present study was to investigate the risk factors related to hospital mortality due to infection in kidney recipients with ARDS meeting the Berlin definition.

METHODS

Univariate and multivariate logistic regression analysis were used to confirm the independent risk factors related to infection-associated mortality.

RESULTS

From January 2001 to August 2014, a total of 94 recipients with acute respiratory dress syndrome (ARDS) caused by pneumonia following kidney transplantation were enrolled in the present study. The most common type of infection was bacterial (52/94; 55.3%), viral (25/94; 26.6%), and polymicrobial (14/94; 14.9%). The most common ARDS was diagnosed within 6 months after transplantation (76/94; 80.9%). There were 39 deaths in these recipients (39/94; 41.5%). Eleven (11.7%) patients had mild, 47 (50.0%) moderate, and 36 (38.3%) severe ARDS; mortality was 27.3, 27.7, and 63.9%, respectively. The independent predictors of infection-related mortality were serum creatinine level >1.5 mg/dL at ARDS onset (OR 3.5 (95%CI 1.2-10.1), p = 0.018) and severe ARDS (OR 3.6 (95%CI 1.4-9.7), p = 0.009) in the multivariate analysis.

CONCLUSION

Infection-related mortality in kidney transplant patients with ARDS was associated with high serum creatinine level and severe ARDS.

Bronchiolitis obliterans organizing pneumonia (BOOP) after renal transplantation

A 42-year-old renal transplant recipient was admitted with fever, anorexia, malaise, nonproductive cough, and dyspnea of 1-week duration. Multiple cultures of blood, sputum, and urine were negative. The possibility of bronchiolitis obliterans with organizing pneumonia (BOOP) was considered when pulmonary infiltrate did not respond to conventional antibiotic therapy. High-resolution computed tomography of the chest revealed patchy air-space consolidation and ground-glass opacities, predominantly located in the periphery of the lungs. Cultures and stains of bronchoalveolar lavage specimen and bronchoscopic biopsy of lung tissue were negative for organisms such as Pneumocystis (carinii) jiroveci, bacteria, Mycobacterium tuberculosis, cytomegalovirus, fungi, and atypical germs, and showed evidence of BOOP. The patient recovered completely after treatment with steroids.