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1.
Clostridium difficile infection is associated with graft loss in solid organ transplant recipients
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A. Cusini C. Béguelin S. Stampf K. Boggian C. Garzoni M. Koller O. Manuel P. Meylan N. J. Mueller H. H. Hirsch M. Weisser C. Berger C. van Delden Swiss Transplant Cohort Study 《American journal of transplantation》2018,18(7):1745-1754
Clostridium difficile infection (CDI) is a leading cause of infectious diarrhea in solid organ transplant recipients (SOT). We aimed to assess incidence, risk factors, and outcome of CDI within the Swiss Transplant Cohort Study (STCS). We performed a case‐control study of SOT recipients in the STCS diagnosed with CDI between May 2008 and August 2013. We matched 2 control subjects per case by age at transplantation, sex, and transplanted organ. A multivariable analysis was performed using conditional logistic regression to identify risk factors and evaluate outcome of CDI. Two thousand one hundred fifty‐eight SOT recipients, comprising 87 cases of CDI and 174 matched controls were included. The overall CDI rate per 10 000 patient days was 0.47 (95% confidence interval ([CI] 0.38‐0.58), with the highest rate in lung (1.48, 95% CI 0.93‐2.24). In multivariable analysis, proven infections (hazard ratio [HR] 2.82, 95% CI 1.29‐6.19) and antibiotic treatments (HR 4.51, 95% CI 2.03‐10.0) during the preceding 3 months were independently associated with the development of CDI. Despite mild clinical presentations, recipients acquiring CDI posttransplantation had an increased risk of graft loss (HR 2.24, 95% CI 1.15‐4.37; P = .02). These findings may help to improve the management of SOT recipients. 相似文献
2.
Erick F. Mayer Gabriela Maron Ronald H. Dallas Jose Ferrolino Li Tang Yilun Sun Lara Danziger‐Isakov Grant C. Paulsen Brian T. Fisher Surabhi B. Vora Janet Englund William J. Steinbach Marian Michaels Michael Green Nava Yeganeh Joy E. Gibson Samuel R. Dominguez Maribeth R. Nicholson Daniel E. Dulek Monica I. Ardura Sujatha Rajan Blanca E. Gonzalez Christy Beneri Betsy C. Herold 《American journal of transplantation》2020,20(8):2133-2142
Hematopoietic cell transplant (HCT) and solid organ transplant (SOT) recipients are at increased risk for Clostridioides difficile infection (CDI). We conducted a multicenter retrospective study to describe the incidence of CDI in children transplanted between January 2010 and June 2013. Nested case‐control substudies, matched 1:1 by transplant type, institution, patient age, and time of year (quartile) of transplant, identified CDI risk factors. Cohorts included 1496 HCT and 1090 SOT recipients. Among HCT recipients, 355 CDI episodes were diagnosed in 265 recipients (18.2%). Nested case‐control study identified prior history of CDI (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.5‐4.7), proton pump inhibitors (PPIs; OR 2.1, 95% CI 1.3‐3.4), and exposure to third‐ (OR 2.4, 95% CI 1.4‐4.2) or fourth‐generation (OR 2.1, 95% CI 1.2‐3.7) cephalosporins as risk factors. Notably, fluoroquinolone exposure appeared protective (OR 0.6, 95% CI 0.3‐0.9). Ninety‐two episodes of CDI were diagnosed among 79 SOT recipients (7.3%), and exposure to PPIs (OR 2.4, 95% CI 1.1‐5.4) and third‐generation cephalosporin therapy (OR 3.9, 95% CI 1.4‐10.5) were identified as risk factors. Strategies to decrease PPI use and changes in the class of prophylactic antibiotics may impact CDI incidence and warrant further study. 相似文献
3.
Matti Lindup Lorena van den Bogaart Dla Golshayan John‐David Aubert Julien Vionnet Julien Regamey Manuel Pascual Oriol Manuel Matteo Mombelli 《American journal of transplantation》2020,20(5):1424-1430
Food‐safety measures are recommended in solid organ transplant (SOT) recipients. However, the actual adherence of patients in a real‐life setting and the impact on the incidence of foodborne infections remain largely unexplored. We performed a survey among SOT recipients followed at our institution, aiming to evaluate their food‐safety behavior. We assessed the incidence of microbiologically proven foodborne infections by chart review. One hundred ninety‐seven SOT recipients (kidney = 117, lung = 35, liver = 29, and heart = 16) participated in the survey. Overall, 17.7% of the participants observed all food‐safety recommendations (22.0% avoided food at risk of contamination while 67.9% applied hygiene recommendations). Patients within the first year after transplantation (odds ratio [OR] 5.42; P = .001) and females (OR 4.67; P = .001) followed food‐safety recommendations more closely. Although the majority of SOT recipients felt concerned and actively sought information on food safety (68%‐70%), only 27% were able to recognize all risks of foodborne infection in hypothetical scenarios. Incidence of proven foodborne infections was 17.9% (95% confidence interval 9.9%‐30.9%) 5 years after transplantation. Importantly, foodborne infections occurred exclusively among patients not following food‐safety recommendations. In summary, most SOT recipients eat foods that make them at risk of foodborne infections. Our results indicate that there is room for improvement in patient education, particularly later after transplantation, and reinforce current food‐safety recommendations. 相似文献
4.
Jonathan Tschopp Arnaud G. L'Huillier Matteo Mombelli Nicolas J. Mueller Nina Khanna Christian Garzoni Dario Meloni Matthaios Papadimitriou‐Olivgeris Dionysios Neofytos Hans H. Hirsch Mac M. Schuurmans Thomas Müller Thierry Berney Jürg Steiger Manuel Pascual Oriol Manuel Christian van Delden 《American journal of transplantation》2020,20(10):2876-2882
Immunocompromised patients may be at increased risk for complications of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. However, comprehensive data of SARS‐CoV‐2 infection in solid organ transplant (SOT) recipients are still lacking. We performed a multicenter nationwide observational study within the Swiss Transplant Cohort Study (STCS) to describe the epidemiology, clinical presentation, treatment and outcomes of the first microbiologically documented SARS‐CoV‐2 infection among SOT recipients. Overall, 21 patients were included with a median age of 56 years (10 kidney, 5 liver, 1 pancreas, 1 lung, 1 heart and 3 combined transplantations). The most common presenting symptoms were fever (76%), dry cough (57%), nausea (33%), and diarrhea (33%). Ninety‐five percent and 24% of patients required hospital and ICU admission, respectively, and 19% were intubated. After a median of 33 days of follow‐up, 16 patients were discharged, 3 were still hospitalized and 2 patients died. These data suggest that clinical manifestations of SARS‐CoV‐2 infection in middle‐aged SOT recipients appear to be similar to the general population without an apparent higher rate of complications. These results need to be confirmed in larger cohorts. 相似文献
5.
6.
Jennifer L. Hsu James J. Enser Trevor McKown Glen E. Leverson John D. Pirsch Timothy M. Hess Nasia Safdar 《Clinical transplantation》2014,28(2):267-273
Knowledge of outcomes of Clostridium difficile infection (CDI) in solid organ transplant (SOT) recipients is limited. To evaluate this population, we undertook a retrospective cohort study of all recipients of kidney and liver transplants diagnosed with CDI at a single center over 14 yr. Data pertaining to all episodes of CDI were collected. Multivariate analysis using logistic regression was performed to determine independent predictors of clinical cure. Overall, 170 patients developed 215 episodes of CDI. Among these patients, 162 episodes (75%) were cured, and in 103 episodes (48%), patients were cured within 14 d. In a multivariate analysis, lack of clinical cure at 14 d was predicted by recurrent episode (0.21, 95% CI 0.06–0.72, p = 0.0128), treatment with vancomycin (OR 0.27, 95% CI 0.1–0.74, p = 0.011), vasopressor support (OR 0.23, 95% CI 0.07–0.76, p = 0.0161), and CDI before the year 2004 (OR 0.44, 95% CI 0.2–0.98, p = 0.0446). The latter three factors are likely markers for severity of illness. In this cohort, 13 patients (8%) died during hospitalization, and 49 patients (29%) died within one yr. No deaths were attributed to CDI. Recurrent episode was a major predictor of treatment failure, suggesting that research into development of therapeutic options for recurrent disease is needed. 相似文献
7.
Marc Puigvehí Dana Hashim Philipp K. Haber Amreen Dinani Thomas D. Schiano Amon Asgharpour Tatyana Kushner Gaurav Kakked Parissa Tabrizian Myron Schwartz Ahmet Gurakar Douglas Dieterich Paolo Boffetta Scott L. Friedman Josep M. Llovet Behnam Saberi 《American journal of transplantation》2020,20(1):220-230
Hepatitis C virus infection has been the most common etiology in HCC‐related liver transplantation (LT). Since 2014, direct‐acting antivirals (DAAs) have dramatically improved HCV cure. We aimed to study the changing pattern of etiologies and impact in outcome in HCC‐related LT according to HCV treatment‐era through retrospective analysis of the Scientific Registry of Transplant Recipients (SRTR) database (1987‐2017). A total of 27 855 HCC‐related liver transplants were performed (median age 59 years, 77% male). In the DAA era (2014‐2017) there has been a 14.6% decrease in LT for HCV‐related HCC; however, HCV remains the most common etiology in 50% of cases. In the same era, there has been a 50% increase in LT for NAFLD‐related HCC. Overall survival was significantly worse for HCV‐related HCC compared to NAFLD‐related HCC during pre‐DAA era (2002‐2013; P = .031), but these differences disappeared in the DAA era. In addition, HCV patients had a significant improvement in survival when comparing the DAA era with IFN era (P < .001). Independent predictors of survival were significantly different in the pre‐DAA era (HCV, AFP, diabetes) than in the DAA era (tumor size). HCV‐related HCC continues to be the main indication for LT in the DAA era, but patients’ survival has significantly improved and is comparable to that of NAFLD‐related HCC. 相似文献
8.
Geraldine Blanchard‐Rohner Natalia Enriquez Barbara Lemaître Gianna Cadau Christophe Combescure Emiliano Giostra Karine Hadaya Philippe Meyer Paola M. Gasche‐Soccal Thierry Berney Christian van Delden Claire‐Anne Siegrist 《American journal of transplantation》2019,19(2):512-521
Solid organ transplant (SOT) candidates may not be immune against potentially vaccine‐preventable diseases because of insufficient immunizations and/or limited vaccine responses. We evaluated the impact on vaccine immunity at transplant of a systematic vaccinology workup at listing that included (1) pneumococcal with and without influenza immunization, (2) serology‐based vaccine recommendations against measles, varicella, hepatitis B virus, hepatitis A virus, and tetanus, and (3) the documentation of vaccines and serology tests in a national electronic immunization registry ( www.myvaccines.ch ). Among 219 SOT candidates assessed between January 2014 and November 2015, 54 patients were transplanted during the study. Between listing and transplant, catch‐up immunizations increased the patients’ immunity from 70% to 87% (hepatitis A virus, P = .008), from 22% to 41% (hepatitis B virus, P = .008), from 77% to 91% (tetanus, P = .03), and from 78% to 98% (Streptococcus pneumoniae, P = .002). Their immunity at transplant was significantly higher against S. pneumoniae (P = .006) and slightly higher against hepatitis A virus (P = .07), but not against hepatitis B virus, than that of 65 SOT recipients transplanted in 2013. This demonstrates the value of a systematic multimodal serology‐based approach of immunizations of SOT candidates at listing and the need for optimized strategies to increase their hepatitis B virus vaccine responses. 相似文献
9.
Robin K. Avery Teresa Po-Yu Chiang Kieren A. Marr Daniel C. Brennan Afrah S. Sait Brian T. Garibaldi Pali Shah Darin Ostrander Seema Mehta Steinke Nitipong Permpalung Willa Cochran Martin A. Makary Jacqueline Garonzik-Wang Dorry L. Segev Allan B. Massie 《American journal of transplantation》2021,21(7):2498-2508
10.
These updated guidelines from the American Society of Transplantation Infectious Diseases Community of Practice address the prevention and management of Clostridium difficile infection in solid organ transplant (SOT) recipients. Clostridioides (formerly Clostridium) difficile infection (CDI) is among the most common hospital acquired infections. In SOT recipients, the incidence of CDI varies by type and number or organs transplanted. While a meta‐analysis of published literature found the prevalence of postoperative CDI in the general surgical population to be approximately 0.51%, the prevalence of CDI that is seen in the solid organ transplant population ranges from a low of 3.2% in the pancreatic transplant population to 12.7% in those receiving multiple organ transplants. There are no randomized, controlled trials evaluating the management of CDI in the SOT population. Herein is a review and summary of the currently available literature that has been synthesized into updated treatment guidelines for the management of CDI in the SOT population. 相似文献
11.
《Transplantation proceedings》2021,53(10):2826-2832
BackgroundThere is limited knowledge about risk factors for Clostridioides difficile infection (CDI) and recurrent CDI in solid organ transplant (SOT) recipients.MethodsA case-control study of CDI in SOT recipients compared with controls (SOT recipients who did not present CDI).ResultsSixty-seven patients from 1089 SOT recipients (6.2%) suffered at least one episode of CDI. The mean age was 55 ± 12 years and 20 cases (69%) were men. The accumulated incidence was 8% in liver transplantation, 6.2% in lung transplantation, 5.4% in heart transplantation, and 4.7% in kidney transplantation. Twenty-nine cases (43.3%) were diagnosed during the first 3 months after SOT. Forty-one cases (61.2%) were hospital acquired. Thirty-one patients with CDI presented with mild-moderate infection (46.3%), 30 patients with severe infection (44.8%), and 6 patients with severe-complicated disease (9%). Independent variables found to be related with CDI were hospitalization in the previous 3 months (odds ratio: 2.99; [95% confidence interval 1.21-7.37]) and the use of quinolones in the previous month (odds ratio: 3.71 [95% confidence interval 1.16-11.8]). Eleven patients (16.4%) had at least one recurrence of CDI. Previous treatment with amoxicillin-clavulanate, severe-complicated index episode, and high serum creatinine were associated with recurrent CDI in the univariant analysisConclusionsLiver transplant recipients presented the highest incidence of CDI among SOT recipients. Risk factors for CDI were hospitalization in the previous 3 months and the use of quinolones in the previous month. 相似文献
12.
Saima Aslam Andrew M. Courtwright Christine Koval Susan M. Lehman Sandra Morales Carrie‐Lynn Langlais Furr Francisco Rosas Michael J. Brownstein Joseph R. Fackler Brittany M. Sisson Biswajit Biswas Matthew Henry Truong Luu Brittany N. Bivens Theron Hamilton Christopher Duplessis Cathy Logan Nancy Law Gordon Yung Jason Turowski Judith Anesi Steffanie A. Strathdee Robert T. Schooley 《American journal of transplantation》2019,19(9):2631-2639
Bacteriophage therapy (BT) uses bacteriophages to treat pathogenic bacteria and is an emerging strategy against multidrug‐resistant (MDR) infections. Experience in solid organ transplant is limited. We describe BT in 3 lung transplant recipients (LTR) with life‐threatening MDR infections caused by Pseudomonas aeruginosa (n = 2) and Burkholderia dolosa (n = 1). For each patient, lytic bacteriophages were selected against their bacterial isolates. BT was administered for variable durations under emergency Investigational New Drug applications and with patient informed consent. Safety was assessed using clinical/laboratory parameters and observed clinical improvements described, as appropriate. All patients received concurrent antibiotics. Two ventilator‐dependent LTR with large airway complications and refractory MDR P. aeruginosa pneumonia received BT. Both responded clinically and were discharged from the hospital off ventilator support. A third patient had recurrent B. dolosa infection following transplant. Following BT initiation, consolidative opacities improved and ventilator weaning was begun. However, infection relapsed on BT and the patient died. No BT‐related adverse events were identified in the 3 cases. BT was well tolerated and associated with clinical improvement in LTRs with MDR bacterial infection not responsive to antibiotics alone. BT may be a viable adjunct to antibiotics for patients with MDR infections. 相似文献
13.
J. P. Donnelly H. E. Wang J. E. Locke R. B. Mannon M. M. Safford J. W. Baddley 《American journal of transplantation》2015,15(11):2970-2977
Clostridium difficile infection (CDI) is a considerable health issue in the United States and represents the most common healthcare‐associated infection. Solid organ transplant recipients are at increased risk of CDI, which can affect both graft and patient survival. However, little is known about the impact of CDI on health services utilization posttransplantation. We examined hospital‐onset CDI from 2012 to 2014 among transplant recipients in the University HealthSystem Consortium, which includes academic medical center–affiliated hospitals in the United States. Infection was five times more common among transplant recipients than among general medicine inpatients (209 vs 40 per 10 000 discharges), and factors associated with CDI among transplant recipients included transplant type, risk of mortality, comorbidities, and inpatient complications. Institutional risk‐standardized CDI varied more than 3‐fold across high‐volume hospitals (infection ratio 0.54–1.82, median 1.04, interquartile range 0.78–1.28). CDI was associated with increased 30‐day readmission, transplant organ complications, cytomegalovirus infection, inpatient costs, and lengths of stay. Total observed inpatient days and direct costs for those with CDI were substantially higher than risk‐standardized expected values (40 094 vs 22 843 days, costs $198 728 368 vs $154 020 528). Further efforts to detect, prevent, and manage CDI among solid organ transplant recipients are warranted. 相似文献
14.
Francisco Lpez‐Medrano Jos Tiago Silva Mario Fernndez‐Ruiz Elisa Vidal Julia Origüen Antonia Calvo‐Cano Enrique Luna‐Huerta Esperanza Merino Domingo Hernndez Cristina Jironda‐Gallegos Rosa Escudero Francesca Gioia Antonio Moreno Cristina Roca Elisa Cordero Darío Janeiro Beatriz Snchez‐Sobrino María Milagro Montero Dolores Redondo Francisco Javier Candel Isabel Prez‐Flores Carlos Armianzas Claudia Gonzlez-Rico María Carmen Farias Emilio Rodrigo Beln Loeches María O. Lpez‐Oliva Miguel Montejo Ricardo Lauzurica Juan Pablo Horcajada Julio Pascual Amado Andrs Jos María Aguado 《American journal of transplantation》2020,20(2):451-462
Oral fosfomycin may constitute an alternative for the treatment of lower urinary tract infections (UTIs) in kidney transplant recipients (KTRs), particularly in view of recent safety concerns with fluroquinolones. Specific data on the efficacy and safety of fosfomycin in KTR are scarce. We performed a retrospective study in 14 Spanish hospitals including KTRs treated with oral fosfomycin (calcium and trometamol salts) for posttransplant cystitis between January 2005 and December 2017. A total of 133 KTRs developed 143 episodes of cystitis. Most episodes (131 [91.6%]) were produced by gram‐negative bacilli (GNB), and 78 (54.5%) were categorized as multidrug resistant (including extended‐spectrum β‐lactamase‐producing Enterobacteriaceae [14%] or carbapenem‐resistant GNB [3.5%]). A median daily dose of 1.5 g of fosfomycin (interquartile range [IQR]: 1.5‐2) was administered for a median of 7 days (IQR: 3‐10). Clinical cure (remission of UTI‐attributable symptoms at the end of therapy) was achieved in 83.9% (120/143) episodes. Among those episodes with follow‐up urine culture, microbiological cure at month 1 was achieved in 70.2% (59/84) episodes. Percutaneous nephrostomy was associated with a lower probability of clinical cure (adjusted odds ratio: 10.50; 95% confidence interval: 0.98‐112.29; P = 0.052). In conclusion, fosfomycin is an effective orally available alternative for treating cystitis among KTRs. 相似文献
15.
An early experience on the effect of solid organ transplant status on hospitalized COVID-19 patients
Vinay Nair Nicholas Jandovitz Jamie S. Hirsch Mersema Abate Sanjaya K. Satapathy Nitzan Roth Santiago J. Miyara Sara Guevara Adam M. Kressel Alec Xiang Grace Wu Samuel D. Butensky David Lin Stephanie Williams Madhu C. Bhaskaran David T. Majure Elliot Grodstein Lawrence Lau Gayatri Nair Ahmed E. Fahmy Aaron Winnick Nadine Breslin Ilan Berlinrut Christine Molmenti Lance B. Becker Prashant Malhotra Pranisha Gautam-Goyal Brian Lima Simon Maybaum Samit K. Shah Ryosuke Takegawa Kei Hayashida Koichiro Shinozaki Lewis W. Teperman Ernesto P. Molmenti Northwell Health COVID- Research Consortium 《American journal of transplantation》2021,21(7):2522-2531
We compared the outcome of COVID-19 in immunosuppressed solid organ transplant (SOT) patients to a transplant naïve population. In total, 10 356 adult hospital admissions for COVID-19 from March 1, 2020 to April 27, 2020 were analyzed. Data were collected on demographics, baseline clinical conditions, medications, immunosuppression, and COVID-19 course. Primary outcome was combined death or mechanical ventilation. We assessed the association between primary outcome and prognostic variables using bivariate and multivariate regression models. We also compared the primary endpoint in SOT patients to an age, gender, and comorbidity-matched control group. Bivariate analysis found transplant status, age, gender, race/ethnicity, body mass index, diabetes, hypertension, cardiovascular disease, COPD, and GFR <60 mL/min/1.73 m2 to be significant predictors of combined death or mechanical ventilation. After multivariate logistic regression analysis, SOT status had a trend toward significance (odds ratio [OR] 1.29; 95% CI 0.99–1.69, p = .06). Compared to an age, gender, and comorbidity-matched control group, SOT patients had a higher combined risk of death or mechanical ventilation (OR 1.34; 95% CI 1.03–1.74, p = .027). 相似文献
16.
Laura N. Walti Catrina Mugglin Daniel Sidler Matteo Mombelli Oriol Manuel Hans H. Hirsch Nina Khanna Nicolas Mueller Christoph Berger Katia Boggian Christian Garzoni Dionysios Neofytos Christian van Delden Cédric Hirzel Swiss Transplant Cohort Study 《American journal of transplantation》2021,21(7):2532-2542
Posttransplant lymphoproliferative disorder (PTLD) is a serious complication of solid organ transplantation (SOT). Most PTLD cases are associated with Epstein–Barr virus (EBV) infection. The role of antiviral prophylaxis or rituximab therapy for prevention of PTLD in SOT recipients is controversial. In a nationwide cohort, we assessed the incidence, presentation, and outcome of histologically proven PTLD. We included 4765 patients with a follow-up duration of 23 807 person-years (py). Fifty-seven PTLD cases were identified; 39 (68%) were EBV positive (EBV+ PTLD). Incidence rates for EBV+ PTLD at 1, 2, and 3 years posttransplant were 3.51, 2.24, and 1.75/1000 py and 0.44, 0.25, and 0.29/1000 py for EBV− PTLD. We did not find an effect of antiviral prophylaxis on early and late EBV+ PTLD occurrence (early EBV+ PTLD: SHR 0.535 [95% CI 0.199–1.436], p = .264; late EBV+ PTLD: SHR 2.213, [95% CI 0.751–6.521], p = .150). However, none of the patients (0/191) who received a rituximab-containing induction treatment experienced PTLD, but 57 of 4574 patients without rituximab induction developed PTLD. In an adjusted restricted mean survival time model, PTLD-free survival was significantly longer (0.104 years [95% CI 0.077–0.131]) in patients receiving rituximab as induction treatment. This study provides novel data on the association of rituximab induction and reduced risk for PTLD. 相似文献
17.
《Seminars in Colon and Rectal Surgery》2014,25(3):163-166
The human gastrointestinal microbiota is composed of a diverse and complex array of bacteria, fungi, and viruses that reside within our gastrointestinal (GI) tract. The microbiota plays a vital role in metabolism, vitamin production, and perhaps most importantly, protection from invasion by pathogenic microorganisms. The modern era of antibiotic use has resulted in unanticipated damage to the microbiota and the disruption of the delicate balance between the microorganisms of which it is composed. Over the last 15 years, there has been an alarming rise in the incidence and severity of Clostridium difficile infection (CDI), with accompanying increases in morbidity and significant mortality. Driven at least in part by the CDI epidemic, fecal microbiota transplantation (FMT) has emerged as an astonishingly effective cure of CDI and has gained widespread acceptance as the treatment of choice for recurrent or relapsing CDI (R-CDI) as well as severe CDI. With the increased practice of FMT in many hospitals, it is pertinent to discuss, from the surgeon׳s perspective, the use of FMT in the various clinical scenarios encountered on the surgical service. 相似文献
18.
《Burns : journal of the International Society for Burn Injuries》2022,48(5):1120-1129
BackgroundThe survival rate of patients with severe burn is positively associated with increasing the incidence of the Clostridioides difficile (C. difficile) infection (CDI). The surviving rate of severe burn patients now has an improved but the incidence of Clostridioides difficile (C. difficile) infection (CDI) has been continues increasing during recent two decades.This study assessed the molecular typing and phenotypic characterization isolates of C. difficile in burn patients with diarrhea, as well as environmental and skin infections with C. difficile spores at a referral burn hospital in Isfahan, Iran. It mainly aimed to evaluate the dominant bacterial structure in the gut microbiome of burned subjects with and without CDI.MethodsIn general, 309 samples were collected from 189 burned patients with hospital-acquired diarrhea and 120 swabs were collected from the healthcare workers’ dominant hands, different sites of patients’ skin, and medical tools. In addition, C. difficile isolates were characterized considering the existence of antibiotic resistance and toxin genes. Clinical cultures with identification of organisms and antibiotic susceptibility were done. C. difficle isolates were then genotyped and compared to clinical outcomes. Finally, the clinical characteristics of the participants were gathered through their records, and the bacterial targets of the gut microbiome were detected using quantitative real-time polymerase chain reaction (PCR).ResultsBased on the findings, 51 C. difficile isolates were detected from 189 severe burn patients hospitalized in the hospital. Further, PCR amplification tcdB and tcdA showed 23 isolates (12.2%) as toxigenic. Overall, 18.3% (22/120) of skin and environment samples demonstrated a positive result for C. difficile colonization. A low concentration of metronidazole and vancomycin (MIC90, 0.5, and 1.2 mg/L) inhibited all toxigenic C. difficile strains. Moreover, these isolates represented the highest rates of resistance to moxifloxacin and clindamycin (MIC90, 0.5, and 1.6 mg/L). A significantly reduced abundance of Clostridium spp., Bacteroidetes, and Bifidobacterium and an increase in the quantity of Firmicutes was observed in the gastrointestinal microbiome of burn patients (P < 0.01). Burn patients with CDI showed a significant decrease in Faecalibacterium prausnitzii (F. prausnitzii) while higher Akkermansia muciniphila (A. muciniphila) loads in comparison with healthy controls (P < 0.001 and P < 0.05). Contrarily, burned cases displayed increased levels of opportunistic pathogenic bacteria including the members of Enterococcus spp. and Escherichia coli (P < 0.05).ConclusionsDespite appropriate infection control strategies in the burn intensive care unit, CDI remains prevalent in severe burn patients. Eventually, the overgrowth of A. muciniphila and the decreased abundance of F. prausnitzii in burn cases with CDI could be potential predictive microbiome biomarkers in burned patients. 相似文献
19.
Lina Quteineh Agnieszka Wjtowicz Pierre‐Yves Bochud Severine Crettol Frederik Vandenberghe Jean‐Pierre Venetz Oriol Manuel Dela Golshayan Roger Lehmann Nicolas J. Mueller Isabelle Binet Christian van Delden Jürg Steiger Paul Mohacsi Jean‐Francois Dufour Paola M. Soccal Zoltan Kutalik Pedro Marques‐Vidal Peter Vollenweider Mike Recher Christoph Hess Manuel Pascual Chin B. Eap 《American journal of transplantation》2019,19(1):238-246
New‐onset diabetes mellitus after transplantation (NODAT) is a complication following solid organ transplantation (SOT) and may be related to immune or inflammatory responses. We investigated whether single nucleotide polymorphisms (SNPs) within 158 immune‐ or inflammation‐related genes contribute to NODAT in SOT recipients. The association between 263 SNPs and NODAT was investigated in a discovery sample of SOT recipients from the Swiss Transplant Cohort Study (STCS, n1 = 696). Positive results were tested in a first STCS replication sample (n2 = 489) and SNPs remaining significant after multiple test corrections were tested in a second SOT replication sample (n3 = 156). Associations with diabetic traits were further tested in several large general population‐based samples (n > 480 000). Only SP110 rs2114592C>T remained associated with NODAT in the STCS replication sample. Carriers of rs2114592‐TT had 9.9 times (95% confidence interval [CI]: 3.22‐30.5, P = .00006) higher risk for NODAT in the combined STCS samples (n = 1184). rs2114592C>T was further associated with NODAT in the second SOT sample (odds ratio: 4.8, 95% CI: 1.55‐14.6, P = .006). On the other hand, SP110 rs2114592C>T was not associated with diabetic traits in population‐based samples, suggesting a specific gene‐environment interaction, possibly due to the use of specific medications (ie, immunosuppressants) in transplant patients and/or to the illness that may unmask the gene effect. 相似文献
20.
Maura Faraci Alice Bertaina Arnaud Dalissier Marianne Ifversen Ansgar Schulz Andrew Gennery Birgit Burkhardt Isabel Badell Serra Cristina Diaz‐de‐Heredia Edoardo Lanino Arjan C. Lankester Bernd Gruhn Susanne Matthes‐Martin Joern S. Kühl Stefania Varotto Catherine Paillard Audrey Guilmatre Ana Sastre Manuel Abecasis Birgit Garwer Petr Sedlacek Jaap J. Boelens Eric Beohou Peter Bader 《American journal of transplantation》2019,19(6):1798-1805
We report data obtained from a retrospective multicenter pediatric survey on behalf of the European Society for Blood and Marrow Transplantation (EBMT). Information on solid organ transplantation (SOT) performed in pediatric recipients of either autologous or allogeneic hematopoietic stem cell transplantation (HSCT) between 1984 and 2016 was collected in 20 pediatric EBMT Centers (25.6%). Overall, we evaluated data on 44 SOTs following HSCT including 20 liver (LTx), 12 lung (LuTx), 6 heart (HTx), and 6 kidney (KTx) transplantations. The indication for SOT was organ failure related to intractable graft‐vs‐host disease in 16 children (36.3%), acute or chronic HSCT‐related toxicity in 18 (40.9%), and organ dysfunction related to the underlying disease in 10 (22.8%). The median follow‐up was 10.9 years (95% confidence interval: 1.7‐29.5). The overall survival rate at 1 and 5 years after SOT was 85.7% and 80.4%, respectively: it was 74% and 63.2% after LTx, 83.2% after HTx, and 100% equally after LuTx and KTx. This multicenter survey confirms that SOT represents a promising option in children with severe organ failure occurring after HSCT. Additional studies are needed to further establish the effectiveness of SOT after HSCT and to better understand the mechanism underlying this encouraging success. 相似文献