The American Society of Transplantation Online Transplant Infectious Diseases Library

Despite the overall decline in the frequency of documented gram-negative infections in transplant recipients receiving antimicrobial prophylaxis, the proportion of these infections caused by nonfermentative gram-negative bacilli (NFGNB) is increasing. Pseudomonas aeruginosa is the most common species of NFGNB isolated from such patients, from both monomicrobial and polymicrobial infections. The spectrum of infection caused by P. aeruginosa is wide, and involvement of multiple organ systems...

Over the last 70 years, a steady growth in population of patients with severe and mostly iatrogenically induced immune suppression while undergoing myeloablative antineoplastic therapy and blood- and marrow-derived stem cell or solid organ transplantation has resulted in a near-explosive growth of opportunistic infections. Furthermore, the advent and now common use of biologic immunosuppressive drugs are given to an increasing number of patients prior to transplantation or for treatment of...

In the general population, cytomegalovirus (CMV) is a common infection that is frequently acquired at a young age; one in three children in the United States are infected with CMV. In patients undergoing transplantation, CMV most frequently presents as reactivation of a remotely acquired infection, whereas primary CMV infection in seronegative (−) recipients transmitted via allografts harvested from CMV-seropositive (+) donors poses the greatest threat of infection and viral end-organ...

Gram-positive bacteria (GPB) are an important cause of systemic disease in immunocompromised patients, especially those undergoing transplantation. A rise in infections due to GPB in the last two decades has been attributed to a variety of reasons that prominently include antimicrobial prophylaxis with a focus on prevention of Gram-negative bacterial infections. The near-universal use of indwelling intravascular access devices that are usually retained for an extended duration also...

The use of intravascular devices for administration of drugs, fluids, blood products, and nutritional support is essential in patients undergoing transplantation procedures. These intravascular devices have a significant potential to produce iatrogenic disease, such as bloodstream infection originating from colonization of the indwelling intravascular devices. Over two-thirds of all healthcare-associated bacteremia originate from devices used for vascular access. Patients undergoing...

Surgical site infections (SSIs) following transplantation have been linked to increased mortality, graft rejection, increased length of stay, and increased resource utilization ). Rates of SSI vary and can reach as high as 37% for some transplant procedures . The risk of infection depends greatly on type of surgery and patient-specific factors. Postoperative wound infections following transplant generally occur within 30 days of surgery and can range from superficial to organ/space...

Aspergillus species are ubiquitous fungi that infect humans after their asexual spores are inhaled and deposited in the respiratory tract. Neutrophils and cell-mediated immunity are crucial components of host defenses that prevent invasion of Aspergillus, and these elements are often lacking or impaired in transplant recipients. Aspergillosis is the most common invasive fungal infection in hematopoietic stem cell transplant recipients and the second most common in solid organ transplant...

There are numerous fungal pathogens which merit consideration in the hematopoietic cell and solid organ transplant recipients including yeasts, filamentous molds, and endemic fungi. Important differences in the incidence, types, and timeline of infections exist among the differing transplant groups. The overall risk of invasive fungal infection is affected by a multitude of factors including the transplant donor and recipient as well as transplant type. These considerations guide the...

The Enteroviridae are single-stranded RNA viruses in the Picornaviridae family notable for their ability to cause a wide range of diseases, with more severe disease manifestations in the immunocompromised host. Humans are the reservoir for Enteroviridae, and person-to-person transmission occurs via the fecal-oral or respiratory route. Intact innate immune response including NK cells and macrophages plays an important role during the initial phase of infection followed by T- and B-cell...

Transplant infectious diseases are among the most challenging sectors of present-day medicine. Solid organ and hematopoietic stem cell transplants are being performed with increasing frequency, and the threat of infection is ever-present due to a degree of dependence upon potent immunosuppressive agents that ensure sustained engraftment. Accordingly, antibacterial agents will be employed as well. The responses of these patients to bacterial infection can be very different when compared to...

Viral infections are a global public health problem and can contribute significantly to patient morbidity and mortality. It is estimated that there are 350 million people worldwide who are infected with hepatitis B virus and 17,000 new cases per year of hepatitis C are identified (Wasley et al., MMWR Morb Mortal Wkly Rep 57(SS-2):1–24, 2008). Herpes viruses are common, with an estimated seroprevalence of 50% for herpes simplex virus type-1 and 20% herpes simplex virus type-2 seroprevalence...

Caring for immunocompromised patients is challenging. Despite significant advances, infection remains a major cause of morbidity and mortality, and as such, these patients are frequently exposed to antimicrobial agents. Antimicrobial stewardship programs (ASPs) can assist transplant centers in optimizing antibiotic usage, particularly in this age of growing microbial resistance and the scarcity of new anti-infective agents in development. The collaborative approach of antimicrobial...

These updated AST-IDCOP guidelines review the epidemiology, diagnosis, and management of emerging fungi after organ transplantation. Infections due to numerous generally innocuous fungi are increasingly recognized in solid organ transplant (SOT) recipients, comprising about 7%-10% of fungal infections in this setting. Such infections are collectively referred to as emerging fungal infections and include Mucormycetes, Fusarium, Scedosporium, and dematiaceous fungi among others. The causative...

The first line and the most effective form of antifungal host defense are comprised by phagocytes, particularly neutrophils and monocytes/macrophages that play a central role in local containment of infection and prevent systemic dissemination. These immune cells are also exposed to antifungal drugs while patients undergo systemic antifungal therapy. In the phagocyte-fungus-antifungal drug interplay, drugs including amphotericin B formulations, azoles, and echinocandins may directly interact...

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation provide an update on potential drug-drug interactions between anti-infectives and immunosuppressants, which are most notable with calcineurin and mTOR inhibitors. Drug-drug interactions may occur through pharmacokinetic mechanisms leading to altered drug concentrations of either the anti-infective or immunosuppressive drug, or by pharmacodynamic interactions increasing or...

Mucormycosis (formerly known as zygomycosis) is a life-threatening infection caused by fungi of the order Mucorales. Mucormycosis is an infectious emergency that typically occurs in patients with defects in host defense and/or with increased available serum iron, but can also occur after traumatic implantation of the etiologic fungi through skin. Recent years have witnessed some dramatic changes in the fungal taxonomy, etiology, epidemiology, and therapy of and outcomes from such infections, including in the transplant setting.

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of tuberculosis in the pre- and post-transplant period. The challenges of screening for both latent and active TB in the setting of transplantation are reviewed. The use of interferon gamma release assays for detection of latent tuberculosis is discussed and compared to tuberculin skin testing. Given the limitations of both...

Viral infections account for a large proportion of emerging infectious diseases, and the agents included in this group consist of recently identified viruses as well as previously identified viruses with an apparent increase in disease incidence. In transplant recipients, this group can include viruses with no recognized pathogenicity in immunocompetent patients and those that result in atypical or more severe disease presentations in the immunocompromised host. In this chapter, we begin by...

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of viral hepatitis in the pre- and post-transplant period. The current guidelines reflect the declining need for hepatitis B immunoglobulin following liver transplant, now replaced with nucleos(t)ide analogues that effectively suppress viral replication for the long term with minimal risk for drug resistance. It describes the...

Prevention of infection is important in the susceptible patients undergoing transplantation. Accurate diagnosis continues to be a challenge, and response to treatment is often suboptimal, mainly due to immune defects that cannot be corrected during the course of an infection episode. Antimicrobial drugs are the cornerstone for prevention of opportunistic and other routinely encountered infections in patients undergoing solid organ and hematopoietic stem cell allograft transplantation....