In the Journals

Bacteria cause majority of infections in first year after solid organ transplant

Solid organ transplant recipients experienced a high burden of infections, more than half of which were due to bacteria, in the first year after transplant, according to an analysis of patients in the Swiss Transplant Cohort Study.

“Solid organ transplant (SOT) recipients require long-term immunosuppression and are at risk for life-threatening infections,” Christian van Delden, MD, of the Transplant Infectious Diseases Unit at the University Hospitals Geneva, and colleagues wrote. “Knowledge of timing and relative frequencies of infections in the era of extended donor/recipient criteria, modern immunosuppression, routine use of prophylaxis and active surveillance of viral replication is crucial for implementing prevention strategies to further reduce morbidity and mortality associated with post-transplant infections.”

In a prospective analysis of patients in the Swiss Transplant Cohort Study, which includes nearly all SOT recipients in Switzerland, transplant-infectious diseases physicians categorized all clinically relevant infections in persons who received SOT from May 2008 through December 2014 who had at least 12 months of follow-up.

The researchers identified 2,761 eligible SOTs. Among those patients, 1,520 patients (55%) experienced 3,520 infections during their first year after transplant, although the burden and timelines of infections was different between transplantations.

Most of the infections that occurred over the year (n = 2,202; 63%) were caused by bacteria, with a “predominance” of Enterobacteriaceae (54%) as urinary pathogens in heart, lung and kidney transplant recipients and as digestive tract pathogens in liver transplant recipients. Enterococcus species (20%) were seen as urinary tract pathogens in kidney transplant recipients and as digestive tract pathogens in liver transplant recipients; Pseudomonas aeruginosa accounted for 9% of infections in lung transplant recipients.

Of the 1,039 viral infections that occurred, van Delden and colleagues found that herpes viruses predominated (51%) in kidney, liver and heart transplant recipients. Additionally, of the 263 fungal infections that developed, Candida species accounted for 60% as digestive tract pathogens in liver transplant recipients.

Opportunistic pathogens, including Aspergillus fumigatus (1.4%) and cytomegalovirus (6%), were uncommon, scattered across 12 months among all SOT recipients.

“The transplant-specific timelines presented here should help clinicians to target patient-adapted prophylactic and empiric treatments,” the authors concluded. “The high burden of Enterobacteriaceae, Pseudomonas and Enterococcus, with rising antimicrobial resistance, is worrisome and urges for the development of new approaches and antimicrobials to guarantee improved graft and patient survival.” – by Caitlyn Stulpin

Disclosures: van Delden reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Solid organ transplant recipients experienced a high burden of infections, more than half of which were due to bacteria, in the first year after transplant, according to an analysis of patients in the Swiss Transplant Cohort Study.

“Solid organ transplant (SOT) recipients require long-term immunosuppression and are at risk for life-threatening infections,” Christian van Delden, MD, of the Transplant Infectious Diseases Unit at the University Hospitals Geneva, and colleagues wrote. “Knowledge of timing and relative frequencies of infections in the era of extended donor/recipient criteria, modern immunosuppression, routine use of prophylaxis and active surveillance of viral replication is crucial for implementing prevention strategies to further reduce morbidity and mortality associated with post-transplant infections.”

In a prospective analysis of patients in the Swiss Transplant Cohort Study, which includes nearly all SOT recipients in Switzerland, transplant-infectious diseases physicians categorized all clinically relevant infections in persons who received SOT from May 2008 through December 2014 who had at least 12 months of follow-up.

The researchers identified 2,761 eligible SOTs. Among those patients, 1,520 patients (55%) experienced 3,520 infections during their first year after transplant, although the burden and timelines of infections was different between transplantations.

Most of the infections that occurred over the year (n = 2,202; 63%) were caused by bacteria, with a “predominance” of Enterobacteriaceae (54%) as urinary pathogens in heart, lung and kidney transplant recipients and as digestive tract pathogens in liver transplant recipients. Enterococcus species (20%) were seen as urinary tract pathogens in kidney transplant recipients and as digestive tract pathogens in liver transplant recipients; Pseudomonas aeruginosa accounted for 9% of infections in lung transplant recipients.

Of the 1,039 viral infections that occurred, van Delden and colleagues found that herpes viruses predominated (51%) in kidney, liver and heart transplant recipients. Additionally, of the 263 fungal infections that developed, Candida species accounted for 60% as digestive tract pathogens in liver transplant recipients.

Opportunistic pathogens, including Aspergillus fumigatus (1.4%) and cytomegalovirus (6%), were uncommon, scattered across 12 months among all SOT recipients.

“The transplant-specific timelines presented here should help clinicians to target patient-adapted prophylactic and empiric treatments,” the authors concluded. “The high burden of Enterobacteriaceae, Pseudomonas and Enterococcus, with rising antimicrobial resistance, is worrisome and urges for the development of new approaches and antimicrobials to guarantee improved graft and patient survival.” – by Caitlyn Stulpin

Disclosures: van Delden reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.