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Hamandi B, Law N, Alghamdi A, Husain S, Papadimitropoulos EA. Clinical and economic burden of infections in hospitalized solid organ transplant recipients compared with the general population in Canada - a retrospective cohort study. Transpl Int 2019; 32:1095-1105. [PMID: 31144787 DOI: 10.1111/tri.13467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/05/2019] [Accepted: 05/25/2019] [Indexed: 12/16/2022]
Abstract
Infections continue to be a major cause of post-transplant morbidity and mortality, requiring increased health services utilization. Estimates on the magnitude of this impact are relatively unknown. Using national administrative databases, we compared mortality, acute care health services utilization, and costs in solid organ transplant (SOT) recipients to nontransplant patients using a retrospective cohort of hospitalizations in Canada (excluding Manitoba/Quebec) between April-2009 and March-2014, with a diagnosis of pneumonia, urinary tract infection (UTI), or sepsis. Costs were analyzed using multivariable linear regression. We examined 816 324 admissions in total: 408 352 pneumonia; 328 066 UTI's; and 128 275 sepsis. Unadjusted mean costs were greater in SOT compared to non-SOT patients with pneumonia [(C$14 923 ± C$29 147) vs. (C$11 274 ± C$18 284)] and sepsis [(C$23 434 ± C$39 685) vs. (C$20 849 ± C$36 257)]. Mortality (7.6% vs. 12.5%; P < 0.001), long-term care transfer (5.3% vs. 16.5%; P < 0.001), and mean length of stay (11.0 ± 17.7 days vs. 13.1 ± 24.9 days; P < 0.001) were lower in SOT. More SOT patients could be discharged home (63.2% vs. 44.3%; P < 0.001), but required more specialized care (23.5% vs. 16.1%; P < 0.001). Adjusting for age and comorbidities, hospitalization costs for SOT patients were 10% (95% CI: 8-12%) lower compared to non-SOT patients. Increased absolute hospitalization costs for these infections are tempered by lower adjusted costs and favorable clinical outcomes.
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Affiliation(s)
- Bassem Hamandi
- Department of Pharmacy, University Health Network, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Nancy Law
- Division of Infectious Diseases, Multi-Organ Transplant Program, University of Toronto, University Health Network, Toronto, ON, Canada
| | - Ali Alghamdi
- Division of Infectious Diseases, Multi-Organ Transplant Program, University of Toronto, University Health Network, Toronto, ON, Canada
| | - Shahid Husain
- Division of Infectious Diseases, Multi-Organ Transplant Program, University of Toronto, University Health Network, Toronto, ON, Canada
| | - Emmanuel A Papadimitropoulos
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.,Eli Lilly & Company, Toronto, ON, Canada
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Polat KY, Tosun MS, Ertekin V, Aydinli B, Emre S. Brucella infection with pancytopenia after pediatric liver transplantation. Transpl Infect Dis 2012; 14:326-9. [PMID: 22260451 DOI: 10.1111/j.1399-3062.2011.00709.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 08/08/2011] [Accepted: 10/06/2011] [Indexed: 12/15/2022]
Abstract
Brucellosis is considered the most widespread zoonosis in the world. It has been reported that the prevalence of seropositivity among the Turkish population varies from 3% to 14%. We present a case of brucellosis after pediatric liver transplantation. A 15-year-old boy with the diagnosis of neuro Wilson's disease underwent deceased-donor liver transplantation. The postoperative immunosuppressive protocol consisted of steroids and tacrolimus. Two months after the operation the patient experienced fever to 40°C. The patient complained of poor appetite, headache, and diarrhea. He had had pancytopenia. Despite administration of appropriate antibiotics, antiviral and antifungal agents, fever persisted for > 1 month. Multiple blood, urine, stool, and sputum cultures were negative. Bone marrow aspirate revealed hypocellularity. Liver biopsy was performed, but rejection was not observed on biopsy specimen. Brucella serology was positive and Brucella agglutination titer was 1:320. Bone marrow culture was positive for Brucella but blood culture was negative. The patient was then treated with oral doxycycline and rifampin for 8 weeks. No previous case report about Brucella infection after liver transplantation has appeared in the literature, to our knowledge; our case is presented as the first. Bone marrow hypoplasia is a rare feature of Brucella infection. Our patient with brucellosis and pancytopenia had had hypocellular bone marrow. The clinical and hematologic findings resolved with treatment of the infection. Brucella infection should be suspected in liver transplanted recipients with fever of unknown origin, especially in a recipient who has lived in an endemic area. Brucella also should be considered as a possible diagnosis in patients with pancytopenia.
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Affiliation(s)
- K Y Polat
- Department of Transplant Surgery, Memorial Atasehir Hospital, Istanbul, Turkey
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Rahier JF, Moutschen M, Van Gompel A, Van Ranst M, Louis E, Segaert S, Masson P, De Keyser F. Vaccinations in patients with immune-mediated inflammatory diseases. Rheumatology (Oxford) 2010; 49:1815-27. [PMID: 20591834 PMCID: PMC2936949 DOI: 10.1093/rheumatology/keq183] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 05/11/2010] [Indexed: 12/20/2022] Open
Abstract
Patients with immune-mediated inflammatory diseases (IMID) such as RA, IBD or psoriasis, are at increased risk of infection, partially because of the disease itself, but mostly because of treatment with immunomodulatory or immunosuppressive drugs. In spite of their elevated risk for vaccine-preventable disease, vaccination coverage in IMID patients is surprisingly low. This review summarizes current literature data on vaccine safety and efficacy in IMID patients treated with immunosuppressive or immunomodulatory drugs and formulates best-practice recommendations on vaccination in this population. Especially in the current era of biological therapies, including TNF-blocking agents, special consideration should be given to vaccination strategies in IMID patients. Clinical evidence indicates that immunization of IMID patients does not increase clinical or laboratory parameters of disease activity. Live vaccines are contraindicated in immunocompromized individuals, but non-live vaccines can safely be given. Although the reduced quality of the immune response in patients under immunotherapy may have a negative impact on vaccination efficacy in this population, adequate humoral response to vaccination in IMID patients has been demonstrated for hepatitis B, influenza and pneumococcal vaccination. Vaccination status is best checked and updated before the start of immunomodulatory therapy: live vaccines are not contraindicated at that time and inactivated vaccines elicit an optimal immune response in immunocompetent individuals.
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Affiliation(s)
- Jean-François Rahier
- Department of Gastroenterology, Cliniques Universitaires UCL Mont Godinne, Yvoir, Department of Infectious Diseases, University of Liege, Liege, Clinical Department, Institute of Tropical Medicine Antwerp, Antwerp, Laboratory Medicine, University Hospital Leuven, Department of Gastroenterology, CHU, University of Liege, Liege, Department of Dermatology, University Hospital Leuven, Leuven de Duve Institute, Université Catholique de Louvain, Brussels and Department of Rheumatology, Ghent University, Ghent, Belgium
| | - Michel Moutschen
- Department of Gastroenterology, Cliniques Universitaires UCL Mont Godinne, Yvoir, Department of Infectious Diseases, University of Liege, Liege, Clinical Department, Institute of Tropical Medicine Antwerp, Antwerp, Laboratory Medicine, University Hospital Leuven, Department of Gastroenterology, CHU, University of Liege, Liege, Department of Dermatology, University Hospital Leuven, Leuven de Duve Institute, Université Catholique de Louvain, Brussels and Department of Rheumatology, Ghent University, Ghent, Belgium
| | - Alfons Van Gompel
- Department of Gastroenterology, Cliniques Universitaires UCL Mont Godinne, Yvoir, Department of Infectious Diseases, University of Liege, Liege, Clinical Department, Institute of Tropical Medicine Antwerp, Antwerp, Laboratory Medicine, University Hospital Leuven, Department of Gastroenterology, CHU, University of Liege, Liege, Department of Dermatology, University Hospital Leuven, Leuven de Duve Institute, Université Catholique de Louvain, Brussels and Department of Rheumatology, Ghent University, Ghent, Belgium
| | - Marc Van Ranst
- Department of Gastroenterology, Cliniques Universitaires UCL Mont Godinne, Yvoir, Department of Infectious Diseases, University of Liege, Liege, Clinical Department, Institute of Tropical Medicine Antwerp, Antwerp, Laboratory Medicine, University Hospital Leuven, Department of Gastroenterology, CHU, University of Liege, Liege, Department of Dermatology, University Hospital Leuven, Leuven de Duve Institute, Université Catholique de Louvain, Brussels and Department of Rheumatology, Ghent University, Ghent, Belgium
| | - Edouard Louis
- Department of Gastroenterology, Cliniques Universitaires UCL Mont Godinne, Yvoir, Department of Infectious Diseases, University of Liege, Liege, Clinical Department, Institute of Tropical Medicine Antwerp, Antwerp, Laboratory Medicine, University Hospital Leuven, Department of Gastroenterology, CHU, University of Liege, Liege, Department of Dermatology, University Hospital Leuven, Leuven de Duve Institute, Université Catholique de Louvain, Brussels and Department of Rheumatology, Ghent University, Ghent, Belgium
| | - Siegfried Segaert
- Department of Gastroenterology, Cliniques Universitaires UCL Mont Godinne, Yvoir, Department of Infectious Diseases, University of Liege, Liege, Clinical Department, Institute of Tropical Medicine Antwerp, Antwerp, Laboratory Medicine, University Hospital Leuven, Department of Gastroenterology, CHU, University of Liege, Liege, Department of Dermatology, University Hospital Leuven, Leuven de Duve Institute, Université Catholique de Louvain, Brussels and Department of Rheumatology, Ghent University, Ghent, Belgium
| | - Pierre Masson
- Department of Gastroenterology, Cliniques Universitaires UCL Mont Godinne, Yvoir, Department of Infectious Diseases, University of Liege, Liege, Clinical Department, Institute of Tropical Medicine Antwerp, Antwerp, Laboratory Medicine, University Hospital Leuven, Department of Gastroenterology, CHU, University of Liege, Liege, Department of Dermatology, University Hospital Leuven, Leuven de Duve Institute, Université Catholique de Louvain, Brussels and Department of Rheumatology, Ghent University, Ghent, Belgium
| | - Filip De Keyser
- Department of Gastroenterology, Cliniques Universitaires UCL Mont Godinne, Yvoir, Department of Infectious Diseases, University of Liege, Liege, Clinical Department, Institute of Tropical Medicine Antwerp, Antwerp, Laboratory Medicine, University Hospital Leuven, Department of Gastroenterology, CHU, University of Liege, Liege, Department of Dermatology, University Hospital Leuven, Leuven de Duve Institute, Université Catholique de Louvain, Brussels and Department of Rheumatology, Ghent University, Ghent, Belgium
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