The American Society of Transplantation Online Transplant Infectious Diseases Library
Full Library 1,578 resources
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Background Vancomycin-resistant enterococci (VRE) colonization is common in liver transplant recipients and has been associated with worse posttransplant outcomes. Methods We conducted a retrospective cohort study at the University of Alberta Hospital including patients who underwent a liver transplant between September 2014 and December 2017. Results Of 343 patients, 68 (19.8%) had pretransplant VRE colonization and 27 (27/275, 9.8%) acquired VRE posttransplant, 67% were males and the...
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Background Antimicrobial stewardship (AMS) is a coherent set of actions to optimize antimicrobial use, improve patient outcomes, and reduce antimicrobial resistance (AMR). Thailand's national strategic plan has included AMS since 2017. Due to an increased risk of infection and AMR, solid organ transplant (SOT) recipients can benefit from antimicrobial stewardship programs (ASPs). However, the AMS in SOT has not been well defined. Balancing ASPs with the need for early and frequent...
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Tumor necrosis factor-α (TNF-α) plays a central role in the immunopathogenesis of a wide variety of inflammatory conditions from diseases such as rheumatoid arthritis to inflammatory bowel diseases. Development of TNF-α inhibitors (TNFI) has revolutionized the ability to treat these conditions, resulting in substantial improvement in clinical outcomes. Since the introduction of infliximab and etanercept in 1998, indications for the use of TNFI have expanded, and these medications are...
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Background Antibiotic stewardship programs (ASPs) are well established in the public hospitals in Singapore, but they are not mandatory for transplant programs. Given the positive impact of ASPs in non-organ transplant patients (improved use of broad-spectrum antibiotics, reduced length of stay, and lower healthcare costs), stewardship principles are likely to benefit transplant recipients. Methods We reviewed the progress made in ASPs in the Asia Pacific region as well as the progress of...
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Background The utility of surveillance bronchoscopy (SB) for the clinical management of lung transplant recipients (LTRs) is undefined. This study evaluates the role of SB in the monitoring and care of LTRs. Methods We retrospectively analyzed all LTRs who had SB at Henry Ford Hospital in Detroit, Michigan between August 2014 and August 2019. Bronchoscopies performed for clinical symptoms, new radiographic abnormalities, and to assess stents or acute rejection were excluded. A total of 107...
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Background Current clinical trials of new antibiotics facilitate bringing new drugs to market but often fail to provide useful information for clinical decision making. Methods Literature review of desirability of outcome ranking (DOOR) in antibiotic clinical trials and description how DOOR can fit into design, administration, and assessment of clinical trials. Results DOOR is an approach that addresses many of the shortcomings of current trials by incorporating efficacy and safety into a...
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This chapter is focused on the agents targeting lymphoid and myeloid cell surface antigens CD22, CD30, CD33, CD38, CD40, SLAMF-7 (CD319), and CCR-4. Over the past 20 years, many monoclonal antibodies targeting these antigens have been developed and introduced into clinical practice. Many of them are used successfully for the treatment of leukemia, lymphoma, multiple myeloma, and systemic autoimmune diseases (e.g. systemic lupus erythematosus, Sjogren’s syndrome) both in monotherapy and in...
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Secondary haemophagocytic lymphohistiocytosis (sHLH) or macrophage activation syndrome (MAS) is a life-threatening hyperinflammatory syndrome that can occur in patients with severe infections, e.g., COVID-19 infection, malignancy or autoimmune diseases. It is also a rare complication of allogeneic haematopoietic cell transplantation (allo-HCT), independent of the underlying trigger mechanism or underlying disorders associated with high mortality. There have been increasing reports of...
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Background The importance of antimicrobial stewardship (AMS) activities specifically focused on solid organ transplant (SOT) recipients is increasingly recognized. In 2014, the Veterans Health Administration (VHA) created national guidance and committed resources to establish AMS programs at Veterans Affairs (VA) medical centers across the country. However, the AMS implementation is at the discretion of individual VA centers. Methods We undertook an environmental scan of AMS activities in a...
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The role of the structurally related interleukin-(IL) 12 and IL-23, as key drivers of Th1 and Th17 differentiation, in the pathogenesis of inflammatory chronic conditions has led to the development of various monoclonal antibodies targeted either at the common p40 subunit shared both cytokines (ustekinumab) or at the IL-23-specific p19 subunit (guselkumab, tildrakizumab, and risankizumab). These IL-12/23-targeted agents are currently approved for the treatment of plaque psoriasis, psoriatic...
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Objectives Stenosis of the biliary anastomosis predisposes liver graft recipients to bacterial cholangitis. Antibiotic therapy (AT) is performed according to individual clinical judgment, but duration of AT remains unclear. Methods All liver graft recipients with acute cholangitis according to the Tokyo criteria grade 1 and 2 after endoscopic retrograde cholangiography (ERC) were included. Outcome of patients treated with short AT (<7 days) was compared to long AT (>6 days). Recurrent...
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Introduction We, in India, have unique challenges in implementing antimicrobial stewardship (AMS) in our institutions, especially the transplant settings. Identifying challenges, addressing them, and finding innovative solutions to these are the need of the hour. Challenges Several challenges in India exists, which hamper implementation of effective AMS like lack of adequately trained personnel (infectious diseases [ID] physicians and clinical pharmacists), missing opportunities of AMS...
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Letermovir is a novel agent for the prevention of cytomegalovirus (CMV) infection and disease that, unlike traditional CMV DNA polymerase inhibitors, does not carry the risk of myelosuppression. The purpose of this study was to evaluate the safety, efficacy, and clinical application of letermovir for CMV prophylaxis in heart transplant (HT) recipients. Between November 1, 2019, and October 1, 2021, at a single, tertiary care hospital, 17 HT recipients were initiated on letermovir due to...
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Background Solid organ transplant (SOT) recipients can benefit from traditional antimicrobial stewardship (AMS) activities directed to improve judicious perioperative prescribing and management, but evidence is lacking. The aim of this expert opinion review is to provide an update on the current landscape of application of AMS practices for optimization of perioperative prophylaxis (PP). Methods We reviewed the available literature on early postoperative infectious complications in SOT and...
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