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Background.  Extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL-E) carriage is frequent among liver transplant (LT) recipients, thereby fostering a large empirical carbapenem prescription. However, ESBL-E infections occur in only 10%–25% of critically ill patients with rectal colonization. Our aim was to identify risk factors for post-LT ESBL-E infection in colonized patients. The effect of perioperative antimicrobial prophylaxis (AP) was also analyzed in patients with...

Nocardia species are ubiquitous, environmental, Gram-positive bacteria belonging to the Actinomycetaceae family. Immunocompromised hosts such as recipients of solid organ and hematopoietic stem cell transplants are more susceptible to infection, and the most commonly affected organ is the lung. The net state of immunosuppression is an important risk factor for development of infection in transplant recipients. Isolation of Nocardia spp. in culture from a clinically suspected site of...

Acinetobacter infections have emerged as an important pathogen in transplant recipients. It is a major cause of multidrug-resistant nosocomial infections, particularly pneumonia and bloodstream infections, and is associated with high morbidity and mortality. Given the organism’s propensity to develop resistance to multiple classes of antibiotics, treatment options can be limited but frequently include carbapenems, polymyxins, sulbactams, tetracyclines, and glycylcyclines. Infection...

Nontuberculous mycobacteria (NTM) are ubiquitous environmental organisms found in soil and water. The expansion of the transplant population combined with an increase in environmental exposures and improvements in mycobacterial diagnosis has contributed to a rise in the diagnosis of NTM infections among transplant recipients, who are at particular risk for infection as well as increased associated morbidity and mortality.

Objectives: To evaluate the efficacy of oral colistin-neomycin in preventing multidrug-resistant Enterobacterales (MDR-E) infections in solid organ transplant (SOT) recipients. Methods: Multicentre, open-label, parallel-group, controlled trial with balanced (1:1) randomization in five transplant units. SOT recipients were screened for MDR-E intestinal colonization (extended-spectrum b-lactamase or carbapenemase producing) before transplantation and þ7 and þ 14 days after transplantation and...

Syphilis is capable of compromising almost any organ; however, syphilitic hepatitis is a rare manifestation that has been described most often in HIV-infected patients. Herein, we present a 33-year-old male liver transplant recipient who presented with progressive liver dysfunction characterized by mild ALT elevation and rising cholestasis, malaise, skin rash, and alopecia. Skin biopsy was characteristic of secondary syphilis, confirmed by both skin and liver biopsy-positive...

As one of the most formidable bacterial pathogens encountered in clinical practice, infections related to Pseudomonas aeruginosa (PsA) present a number of challenges to the infectious disease physician. In immunocompromised hosts in particular, PsA has the potential to manifest with unique, recurrent, and often severe clinical syndromes that warrant infectious disease consultation. A staggering array of virulence factors combined with a host of intrinsic and acquired genetic elements...

The incidence of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (ESBL-EB) and carbapenem-resistant Enterobacterales (CRE) infections has been increasing worldwide, although the prevalence and mechanism of resistance vary by geographic region and institutional patterns of resistance. These multidrug-resistant infections are challenging to diagnose and treat and can cause significant morbidity and mortality in transplant patients. In this chapter we highlight recent trends in...

Background: Nocardiosis is a rare infection that is often difficult to treat and may be life-threatening. There is no consensus on its management. Objectives: Our aim was to provide the current evidence for the diagnosis and management of individuals with nocardiosis, and to propose a management approach for this uncommon infection. Sources: We systematically searched the medical literature on nocardiosis for studies published between 2010 and 2020 and describing ten or more individuals....

Multidrug-resistant organisms (MDROs) cause morbidity and mortality after organ transplantation. Infection from these organisms may arise from pre-transplant colonization/infectious events, and these organisms may be donor-derived. Here we review the epidemiology, clinical manifestations, disease diagnostics, and therapeutic modalities for six common MDRO bacterial pathogens in the context of solid organ and bone marrow transplantation.

Infectious and noninfectious diarrheas are important complications in immunocompromised host (ICH) populations including hematologic stem cell (HSCT) and solid organ transplant (SOT) recipients. Adverse consequences of diarrhea, including fluid and electrolyte imbalances with resultant malabsorption of nutrition and medications, can lead to prolonged hospital stays or rehospitalizations. Clostridioides (formerly Clostridium) difficile is the most common infectious etiology of infectious...

Burkholderia species are found in soil and water and have the ability to cause serious human disease. Infections from these organisms are particularly challenging to manage in the immunocompromised host. Speciation, and identification to strain level, has relevance to virulence, prognosis, and therapeutic strategy – particularly in the case of cystic fibrosis – indicated in lung transplantation. B. pseudomallei complex causes melioidosis and needs to be considered in endemic area travelers or...

This chapter reviews the epidemiology, clinical impact, diagnosis, prevention, and management of tuberculosis (TB) in solid organ and hematopoietic stem cell transplantation. Given the limitations of screening for latent TB using either the tuberculin skin test or interferon gamma release assays, it is important to also consider exposure history and chest imaging; promising new TB diagnostic strategies are currently under development. The clinical manifestations of active tuberculosis in...

The impact of pre-transplant (SOT) carbapenem-resistant Enterobacterales (CRE) colonization or infection on post-SOT outcomes is unclear. We conducted a multi-center, international, cohort study of SOT recipients, with microbiologically diagnosed CRE colonization and/or infection pre-SOT. Sixty adult SOT recipients were included (liver n = 30, hearts n = 17). Klebsiella pneumoniae (n = 47, 78%) was the most common pre-SOT CRE species. Median time from CRE detection to SOT was 2.32 months...

Rapidly growing mycobacteria (RGM) are environmental microorganisms that thrive in water-associated biofilms and grow more quickly in the laboratory than slow-growing nontuberculous mycobacteria. Prevalence of RGM infection appears to be increasing, and patients with structural lung disease and immunocompromised hosts, especially patients with cystic fibrosis or lung transplant recipients, are at increased risk. Transplant recipients can acquire RGM from the community or from healthcare...

Background Multidrug-resistant Gram-negative bacterial infections are increasingly common among solid organ transplant (SOT) recipients, leading to challenges in the selection of empiric antimicrobial therapy. We sought to develop a clinical tool to predict which SOT recipients are at high risk for extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales (EB) bloodstream infection (BSI). Methods A multicenter case-control study was performed. The source population included SOT...

Background HCT leaves patients in a relative state of immune deficiency both during their initial transplant admission and for several years following discharge. NTM are generally harmless colonizers of the outside environment, but for immunocompromised patients, they can cause significant disease due to a paucity of T-cell defense. While routine prophylaxis against NTM is recommended for patients with low CD4 counts in certain clinical settings (eg, AIDS), this is not yet established for...

Background: Immunocompromised individuals are at risk for Nocardia infection, with a recurrence rate of approximately 5%. Solid organ transplant (SOT) recipients often receive secondary prophylaxis due to their requirement of lifelong immunosuppression. However, data supporting this practice is sparse. We sought to evaluate Nocardia recurrence in SOT recipients, specifically evaluating secondary prophylaxis. Methods: We conducted a retrospective cohort study of SOT recipients diagnosed with...