Epidemiology,Risk Factors,and Outcome of Bloodstream Infection Within the First Year After Kidney Transplantation

BackgroundMulti-drug resistant organisms have been emerging among kidney transplant (KT) recipients with bloodstream infections (BSI). The investigation for epidemiology, risk factors and outcome of these infections following KT was initiated.Materials and MethodsA retrospective study of all adult KT recipients who developed a BSI within the first year after KT in 2016 at a single transplant center was conducted. The cumulative incidence of BSI was estimated with Kaplan-Meier methodology. Clinical characteristics and outcome were extracted. Risk factors were analyzed with Cox proportional hazards models.ResultsAmong 171 KT recipients, there were 26 (15.2%) episodes of BSI. Fifty-nine percent were men and the mean ± SD age was 43 ± 12 years. The cumulative incidence of BSIs was 10.1% at 1 month, 13.5% at 6 months, and 15.2% at 12 months. Gram-negative bacteria were responsible for 92% of BSIs, Escherichia coli was the most common pathogen (65%) followed by Klebsiella pneumoniae (11%). Among those, 71% were resistant to extended-spectrum cephalosporins. The genitourinary tracts were the predominant source of BSIs (85%). The second kidney transplantation (HR, 4.55; 95% CI, 1.24–16.79 [P = 0.02]) and receiving induction therapy (HR, 3.05; 95% CI, 1.15‐8.10 [P < 0.03]) were associated with BSI in a multivariate analysis. One patient (4%) developed allograft rejection, allograft failure and death from septic shock.ConclusionsOne out of six KT recipients could develop BSI from gram-negative bacteria within the first year after transplant, particularly in those that received the second transplantation or induction therapy.     

Cardiac involvement in mixed connective tissue disease: A systematic review

Objective

To report the clinical characteristic of cardiac disease in patients with mixed connective tissue disease (MCTD).

Method

We identified published case series that reported cardiac manifestations of patients with MCTD by searching the PubMed database using the search terms “mixed connective tissue disease”. We identified 11 case series that met our eligibility criteria.

Result

616 patients were included. Prevalence of cardiac involvement varied from 13% to 65% depending on patient selection and method used for detection. Pericarditis was the most common cardiac diagnosis with a prevalence of 30% and 43% in two prospective studies. Non-invasive cardiac tests, including electrocardiogram and echocardiogram, detected subclinical cardiac abnormalities in 6%–38% of patients. These abnormalities included conduction abnormalities, pericardial effusion and mitral valve prolapse. Diastolic dysfunction and accelerated atherosclerosis were well-documented in a case–control study. Three prospective studies revealed an overall mortality of 10.4% over the period of follow-up of 13–15 years. 20% of the mortality was directly attributable to cardiac cause.

Conclusion

Cardiac involvement was common among patients with MCTD though the involvement was often clinically inapparent. Non-invasive cardiac tests might have a role for subclinical disease screening for early diagnosis and timely treatment as cardiac involvement was one of the leading causes of mortality.     

Association of Helicobacter pylori with Chronic Kidney Diseases: A Meta-Analysis

Digestive Diseases and Sciences - The reported risk of chronic kidney disease (CKD) in patients with Helicobacter pylori infection is conflicting. This meta-analysis was conducted to summarize all...     

Hepatitis C infection and renal cell carcinoma:A systematic review and meta-analysis

AIM To investigate the association between hepatitis C virus(HCV) infection and risk of renal cell carcinoma(RCC).METHODS A literature search was performed from inception until February 2016.Studies that reported relative risks,odd ratios,hazard ratios or standardized incidence ratio comparing the risk of RCC among HCV-infected participants vs those without HCV infection were included.Participants without HCV infection were used as comparators.Pooled odds ratios and 95%CI were calculated using a random-effect,generic inverse variance method.RESULTS Seven observational studies were with 196826 patients were included in the analysis to assess the risk of RCC in patients with HCV.A significantly increased risk of RCC among participants with HCV infection was found with a pooled RR of 1.86(95%CI:1.11-3.11).The association between RCC and HCV was marginally insignificant after a sensitivity analysis limited only to studies with adjusted analysis,with a pooled RR of 1.50(95%CI:0.93-2.42).CONCLUSION Our study demonstrated a potential association between HCV infection and RCC.Further studies of RCC surveillance in patients with HCV are required.