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Bezinover D, Biancofiore G, Falcone M, Karvellas C, Husain S, Saner FH. Multidrug-resistant infections in solid organ transplant recipients: a focus on risk factors, prevention and treatment strategies. Minerva Anestesiol 2022; 88:735-747. [PMID: 35315621 DOI: 10.23736/s0375-9393.22.16124-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Solid organ transplantation is the best therapeutic option for patients with end-stage organ disease and, according to the data from international registries, there has been a steady increase in numbers and results. However, post-transplant infections remain a fearsome complication with, in the last decade, an increasing incidence of episodes due to antibiotic-resistant bacteria and opportunistic agents. In this paper, we summarize the most relevant and updated knowledge concerning infections from multidrug-resistant germs in solid organ transplant recipients, focusing on risk factors, treatment and prevention strategies, and antimicrobial pharmacokinetics relevant to this particular population of patients.
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Affiliation(s)
- Dmitri Bezinover
- Department of Anesthesiology and Perioperative Medicine, Penn State Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Gianni Biancofiore
- Department of Transplant Anesthesia and Critical Care, AOU Pisana, University of Pisa, Pisa, Italy -
| | - Marco Falcone
- Unit of Infectious Diseases, AOU Pisana, University of Pisa, Pisa, Italy
| | - Costantine Karvellas
- Department of Critical Care Medicine and Gastroenterology/Hepatology, University of Alberta, Edmonton, Canada
| | - Shaid Husain
- Department of Infectious Diseases, Toronto General Hospital Research Institute, Toronto University, Toronto, ON, Canada
| | - Fuat H Saner
- Department of General- and Visceral- and Transplant Surgery, Essen University Medical Center, Essen, Germany
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Vogt PR, Aser R, Schmidlin D, Mohacsi P, Berdat PA, Went P, Flepp M, Mestres CA. Late outcome after surgical and topical treatment for Aspergillus mediastinitis after heart transplantation. J Card Surg 2021; 36:2558-2561. [PMID: 33880792 DOI: 10.1111/jocs.15544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/04/2021] [Accepted: 02/09/2021] [Indexed: 11/29/2022]
Abstract
The 7-year long-term survival after Aspergillus fumigatus mediastinitis after heart transplantation, an uncommonly described condition, is herein reported. A 66-year-old male developed an infection with A. fumigatus covering the entire thoracic cavity with a fungal turf after orthotopic heart transplantation. Repeated surgical removal of infectious and necrotic tissue together with innovative topical treatment using voriconazole and chlorhexidine combined with systemic antifungal treatment, helped in controlling the infection. Definitive wound closure was achieved by standard sternal refixation and latissimus dorsi muscle flap plasty. Survival after A. fumigatus mediastinitis after heart transplantation was achieved with sequential debridement in combination with topical application of antifungal agents.
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Affiliation(s)
- Paul R Vogt
- Department of Cardiovascular Surgery, Klinik Im Park, Zürich, Switzerland.,Department of Cardiovascular Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Raed Aser
- Department of Cardiovascular Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Daniel Schmidlin
- Department of Anaesthesia and Intensive Care, Klinik Im Park, Zürich, Switzerland
| | - Paul Mohacsi
- Department of Cardiology, Klinik Im Park, Zürich, Switzerland
| | - Pascal A Berdat
- Department of Cardiovascular Surgery, Klinik Im Park, Zürich, Switzerland
| | - Phillip Went
- Department of Pathology, Kantonsspital Graubünden, Chur, Switzerland
| | - Markus Flepp
- Department of Infectious Diseases, Klinik Im Park, Zürich, Switzerland
| | - Carlos A Mestres
- Department of Cardiovascular Surgery, University Hospital Zürich, Zürich, Switzerland
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Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations. Transplant Rev (Orlando) 2017; 32:36-57. [PMID: 28811074 DOI: 10.1016/j.trre.2017.07.001] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/02/2017] [Indexed: 12/17/2022]
Abstract
Solid organ transplant (SOT) recipients are especially at risk of developing infections by multidrug resistant (MDR) Gram-negative bacilli (GNB), as they are frequently exposed to antibiotics and the healthcare setting, and are regulary subject to invasive procedures. Nevertheless, no recommendations concerning prevention and treatment are available. A panel of experts revised the available evidence; this document summarizes their recommendations: (1) it is important to characterize the isolate's phenotypic and genotypic resistance profile; (2) overall, donor colonization should not constitute a contraindication to transplantation, although active infected kidney and lung grafts should be avoided; (3) recipient colonization is associated with an increased risk of infection, but is not a contraindication to transplantation; (4) different surgical prophylaxis regimens are not recommended for patients colonized with carbapenem-resistant GNB; (5) timely detection of carriers, contact isolation precautions, hand hygiene compliance and antibiotic control policies are important preventive measures; (6) there is not sufficient data to recommend intestinal decolonization; (7) colonized lung transplant recipients could benefit from prophylactic inhaled antibiotics, specially for Pseudomonas aeruginosa; (8) colonized SOT recipients should receive an empirical treatment which includes active antibiotics, and directed therapy should be adjusted according to susceptibility study results and the severity of the infection.
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Daeschlein G, Napp M, Lutze S, von Podewils S, Jukema G, Fleischmann W, Haase H, Leitgeb J, Ekkernkamp A, Assadian O. Comparison of the effect of negative pressure wound therapy with and without installation of polyhexanide on the bacterial kinetic in chronic wounds. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.wndm.2016.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Romano-Bertrand S, Frapier JM, Calvet B, Colson P, Albat B, Parer S, Jumas-Bilak E. Dynamics of the surgical microbiota along the cardiothoracic surgery pathway. Front Microbiol 2015; 5:787. [PMID: 25628618 PMCID: PMC4292786 DOI: 10.3389/fmicb.2014.00787] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 12/22/2014] [Indexed: 11/13/2022] Open
Abstract
Human skin associated microbiota are increasingly described by culture-independent methods that showed an unexpected diversity with variation correlated with several pathologies. A role of microbiota disequilibrium in infection occurrence is hypothesized, particularly in surgical site infections. We study the diversities of operative site microbiota and its dynamics during surgical pathway of patients undergoing coronary-artery by-pass graft (CABG). Pre-, per-, and post-operative samples were collected from 25 patients: skin before the surgery, superficially and deeply during the intervention, and healing tissues. Bacterial diversity was assessed by DNA fingerprint using 16S rRNA gene PCR and Temporal Temperature Gel Electrophoresis (TTGE). The diversity of Operational Taxonomic Units (OTUs) at the surgical site was analyzed according to the stage of surgery. From all patients and samples, we identified 147 different OTUs belonging to the 6 phyla Firmicutes, Actinobacteria, Proteobacteria, Bacteroidetes, Cyanobacteria, and Fusobacteria. High variations were observed among patients but common themes can be observed. The Firmicutes dominated quantitatively but were largely encompassed by the Proteobacteria regarding the OTUs diversity. The genera Propionibacterium and Staphylococcus predominated on the preoperative skin, whereas very diverse Proteobacteria appeared selected in peri-operative samples. The resilience in scar skin was partial with depletion in Actinobacteria and Firmicutes and increase of Gram-negative bacteria. Finally, the thoracic operative site presents an unexpected bacterial diversity, which is partially common to skin microbiota but presents particular dynamics. We described a complex bacterial community that gathers pathobionts and bacteria deemed to be environmental, opportunistic pathogens and non-pathogenic bacteria. These data stress to consider surgical microbiota as a “pathobiome” rather than a reservoir of individual potential pathogens.
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Affiliation(s)
- Sara Romano-Bertrand
- Equipe Pathogènes et Environnements, UMR 5119 ECOSYM, Université Montpellier 1 Montpellier, France ; Département d'Hygiène Hospitalière, Centre Hospitalier Régional Universitaire de Montpellier Montpellier, France
| | - Jean-Marc Frapier
- Service de Chirurgie Thoracique et Cardiovasculaire, Centre Hospitalier Régional Universitaire de Montpellier Montpellier, France
| | - Brigitte Calvet
- Département de Réanimation de Chirurgie Cardiothoracique, Centre Hospitalier Régional Universitaire de Montpellier Montpellier, France
| | - Pascal Colson
- Département de Réanimation de Chirurgie Cardiothoracique, Centre Hospitalier Régional Universitaire de Montpellier Montpellier, France
| | - Bernard Albat
- Service de Chirurgie Thoracique et Cardiovasculaire, Centre Hospitalier Régional Universitaire de Montpellier Montpellier, France
| | - Sylvie Parer
- Equipe Pathogènes et Environnements, UMR 5119 ECOSYM, Université Montpellier 1 Montpellier, France ; Département d'Hygiène Hospitalière, Centre Hospitalier Régional Universitaire de Montpellier Montpellier, France
| | - Estelle Jumas-Bilak
- Equipe Pathogènes et Environnements, UMR 5119 ECOSYM, Université Montpellier 1 Montpellier, France ; Département d'Hygiène Hospitalière, Centre Hospitalier Régional Universitaire de Montpellier Montpellier, France
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Cervera C, van Delden C, Gavaldà J, Welte T, Akova M, Carratalà J. Multidrug-resistant bacteria in solid organ transplant recipients. Clin Microbiol Infect 2014; 20 Suppl 7:49-73. [DOI: 10.1111/1469-0691.12687] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/16/2014] [Accepted: 05/18/2014] [Indexed: 12/23/2022]
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Tekçe AYT, Erbay A, Çabadak H, Yağcı S, Karabiber N, Şen S. Pan-Resistant Acinetobacter baumannii Mediastinitis Treated Successfully with Tigecycline: A Case Report. Surg Infect (Larchmt) 2011; 12:141-3. [DOI: 10.1089/sur.2009.063] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ayşe Yasemin Tezer Tekçe
- Division of Infectious Diseases and Clinical Microbiology, Türkiye Yüksek Ihtisas Education and Research Hospital, Ankara, Turkey
| | - Ayşe Erbay
- Division of Infectious Diseases and Clinical Microbiology, Türkiye Yüksek Ihtisas Education and Research Hospital, Ankara, Turkey
| | - Hatice Çabadak
- Division of Infectious Diseases and Clinical Microbiology, Türkiye Yüksek Ihtisas Education and Research Hospital, Ankara, Turkey
| | - Serap Yağcı
- Microbiology Laboratory, Türkiye Yüksek Ihtisas Education and Research Hospital, Ankara, Turkey
| | - Nihal Karabiber
- Microbiology Laboratory, Türkiye Yüksek Ihtisas Education and Research Hospital, Ankara, Turkey
| | - Süha Şen
- Division of Infectious Diseases and Clinical Microbiology, Türkiye Yüksek Ihtisas Education and Research Hospital, Ankara, Turkey
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Assadian O, Assadian A, Stadler M, Diab-Elschahawi M, Kramer A. Bacterial growth kinetic without the influence of the immune system using vacuum-assisted closure dressing with and without negative pressure in an in vitro wound model. Int Wound J 2010; 7:283-9. [PMID: 20550601 PMCID: PMC7951651 DOI: 10.1111/j.1742-481x.2010.00686.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The physical capacity of negative pressure wound therapy (NPWT) dressing on the bacterial growth in an in vitro wound model was investigated. Standardised wounds were contaminated with a clinical Staphylococcus aureus strain and incubated at 35 degrees C for 6 hours. Four wounds were treated with continuous negative pressure (125 mmHg) and four controls without. Bacterial load per gram tissue and per gram polyurethane sponge were measured after 24, 36 and 72 hours. Without negative pressure, the initial mean S. aureus load per gram tissue was 1.42 x 10(4), with negative pressure 1.84 x 10(4), P = 0.294. After 24, 36 and 72 hours, both models yielded comparable numbers of organisms (24 hours: P = 0.081; 48 hours: P = 0.455; 72 hours: P = 0.825, respectively). Bacterial load of sponges with or without negative pressure also did not differ. Over a period of 72 hours, sponges with negative pressure yielded 1.60 x 10(8), those without negative pressure yielded 1.74 x 10(8) CFU/g sponge (P = 0.876). In non vital tissue without the influence of the immune system, the bacterial load did not decrease in our in vitro model using an NPWT dressing. This observation was independent of the physical effect of continuous negative pressure at 125 mmHg. The reduction in bacteria demonstrated in previous studies appears to be caused by other effects than physical suction alone. However, the results obtained are limited as non viable tissue was used and the effect of suction on dead tissue might be very different from that occurring on perfused tissue, for example, in an animal model or in patients.
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Affiliation(s)
- Ojan Assadian
- Division of Hospital Hygiene, Clinical Institute for Hygiene and Medical Microbiology, Medical University Vienna, Vienna, Austria.
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Multidrug-resistant Acinetobacter baumannii Pneumonia in Lung Transplant Recipients. J Heart Lung Transplant 2008; 27:804-7. [DOI: 10.1016/j.healun.2008.03.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Revised: 02/01/2008] [Accepted: 03/27/2008] [Indexed: 11/23/2022] Open
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Lachanas E, Tomos P, Sfyras N, Miyakis S, Kostakis A. Acinetobacter baumanniiMediastinitis after Cardiopulmonary Bypass: Case Report and Literature Review. Surg Infect (Larchmt) 2008; 9:201-4. [DOI: 10.1089/sur.2006.097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Elias Lachanas
- 2nd Propedeutic Department of Surgery, Athens University, Laikon Hospital, Athens, Greece
| | - Periklis Tomos
- 2nd Propedeutic Department of Surgery, Athens University, Laikon Hospital, Athens, Greece
| | - Nicolaos Sfyras
- Department of Cardiac Surgery, Ippokrateion Hospital, Athens, Greece
| | - Spiros Miyakis
- 3rd Department of Medicine, Athens University, Sotiria Hospital for Chest Diseases, Athens, Greece
| | - Alkiviadis Kostakis
- 2nd Propedeutic Department of Surgery, Athens University, Laikon Hospital, Athens, Greece
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