Long-term renal graft function and survival in patients with high-risk for cytomegalovirus infection receiving preemptive therapy

BACKGROUND

Preemptive therapy reduces the risk of cytomegalovirus disease in high-risk kidney transplant patients. The advantage of this strategy is that only a fraction of patients receive antiviral drugs for a limited time, which decreases costs and toxicity but requires frequent monitoring and may not prevent complications of asymptomatic cytomegalovirus replication.

MATERIAL AND METHODS

Long-term graft-function and patient survival of high-risk kidney transplant patients who received preemptive therapy guided by pp65 antigenemia was compared to those whose assay remained negative throughout the first post-transplant year.

RESULTS

Between August 1997 and March 2005, 24 of 272 patients were CMV D+/R-. Thirteen of the 24 (54.2%) developed a positive CMV assay during follow-up; the time between transplant and first positive antigenemia was 66.7 +/- 58.3 days (range 29-251 days). Four patients developed symptoms associated with CMV, one of whom succumbed from complications of CMV neumonitis. Overall, no significant differences were observed in SCr, eGFR, delta SCr, and delta eGFR during a 60-month followup between patients who developed CMV infection or disease and those who remained pp65 antigenemia-negative throughout the first 12 post-transplant months. Additionally, no deaths or graft loss occurred during the long-term follow up of this cohort.

CONCLUSIONS

Our results suggest that in this high risk group of kidney transplant recipients, treating CMV replication using a preemptive strategy during the first posttransplant year is associated with a low rate of CMV complications and probably interferes with the alleged long-term negative indirect effects of CMV on kidney function and survival.

Antimicrobial susceptibility patterns and high-level gentamicin resistance among enterococci isolated in a Mexican tertiary care center

AIM

To describe the antimicrobial susceptibility pattern of enterococcal clinical isolates.

SETTING

A 200-bed tertiary-care center in Mexico City.

STUDY DESIGN

Prospective surveillance of enterococcal clinical isolates identified according to Facklam's method since 1990. Susceptibility tests were performed by a commercial micromethod, agar diffusion and microbroth dilution. We present data from 1990 to 1992.

RESULTS

A total of 407 enterococci were recovered during the study period: 245 from inpatients and 162 from outpatients; 325 of the isolates were Enterococcus faecalis, 61 E. faecium, seven E. avium, four each for E. raffinosus and, E. hirae; two, E. pseudoavium; and one each E. gallinarum, E. durans; E. mundtii, and E. faecales var asacharolyticus. Resistance to ampicillin and imipenem among E. faecium was 59%. Among E. faecalis, 0.3% were resistant to ampicillin and 2% to imipenem; no beta-lactamase production was detected. All were susceptible to vancomycin. Overall, a 12% high-level gentamicin resistance (HLGR) was found without a difference between species; 25% of bloodstream clinical isolates were HLGR enterococci. More than half (63%) of the HLGR clinical isolates were susceptible to streptomycin; a-hemolysis in human blood agar as well as nitrofurantoin resistance were observed in all E. faecium isolates and in two E. avium.

CONCLUSIONS

In our center, HLGR has a prevalence of 12%. Streptomycin may be a therapeutic alternative in 63% of the HLGR cases. The pattern of hemolysis in human blood agar plus the susceptibility to nitrofurantoin could be used as an initial screening to identify enterococci.