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      Burden and Timeline of Infectious Diseases in the First Year After Solid Organ Transplantation in the Swiss Transplant Cohort Study

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          Abstract

          Background

          The burden and timeline of posttransplant infections are not comprehensively documented in the current era of immunosuppression and prophylaxis.

          Methods

          In this prospective study nested within the Swiss Transplant Cohort Study (STCS), all clinically relevant infections were identified by transplant–infectious diseases physicians in persons receiving solid organ transplant (SOT) between May 2008 and December 2014 with ≥12 months of follow-up.

          Results

          Among 3541 SOT recipients, 2761 (1612 kidney, 577 liver, 286 lung, 213 heart, and 73 kidney-pancreas) had ≥12 months of follow-up; 1520 patients (55%) suffered 3520 infections during the first year posttransplantation. Burden and timelines of clinically relevant infections differed between transplantations. Bacteria were responsible for 2202 infections (63%) prevailing throughout the year, with a predominance of Enterobacteriaceae (54%) as urinary pathogens in heart, lung, and kidney transplant recipients, and as digestive tract pathogens in liver transplant recipients. Enterococcus spp (20%) occurred as urinary tract pathogens in kidney transplant recipients and as digestive tract pathogens in liver transplant recipients, and Pseudomonas aeruginosa (9%) in lung transplant recipients. Among 1039 viral infections, herpesviruses predominated (51%) in kidney, liver, and heart transplant recipients. Among 263 fungal infections, Candida spp (60%) prevailed as digestive tract pathogens in liver transplant recipients. Opportunistic pathogens, including Aspergillus fumigatus (1.4%) and cytomegalovirus (6%), were rare, scattering over 12 months across all SOT recipients.

          Conclusions

          In the current era of immunosuppression and prophylaxis, SOT recipients experience a high burden of infections throughout the first year posttransplantation, with rare opportunistic pathogens and a predominance of bacteria.

          Abstract

          Data on burden and timeline of infections following solid organ transplantation are currently lacking. This Swiss nationwide cohort study found a high burden of infections throughout the first year posttransplantation, with rare opportunistic pathogens and a predominance of bacteria.

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          Most cited references42

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          Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance.

          A-P Magiorakos, A. Srinivasan, R.B. Carey … (2012)
          Many different definitions for multidrug-resistant (MDR), extensively drug-resistant (XDR) and pandrug-resistant (PDR) bacteria are being used in the medical literature to characterize the different patterns of resistance found in healthcare-associated, antimicrobial-resistant bacteria. A group of international experts came together through a joint initiative by the European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC), to create a standardized international terminology with which to describe acquired resistance profiles in Staphylococcus aureus, Enterococcus spp., Enterobacteriaceae (other than Salmonella and Shigella), Pseudomonas aeruginosa and Acinetobacter spp., all bacteria often responsible for healthcare-associated infections and prone to multidrug resistance. Epidemiologically significant antimicrobial categories were constructed for each bacterium. Lists of antimicrobial categories proposed for antimicrobial susceptibility testing were created using documents and breakpoints from the Clinical Laboratory Standards Institute (CLSI), the European Committee on Antimicrobial Susceptibility Testing (EUCAST) and the United States Food and Drug Administration (FDA). MDR was defined as acquired non-susceptibility to at least one agent in three or more antimicrobial categories, XDR was defined as non-susceptibility to at least one agent in all but two or fewer antimicrobial categories (i.e. bacterial isolates remain susceptible to only one or two categories) and PDR was defined as non-susceptibility to all agents in all antimicrobial categories. To ensure correct application of these definitions, bacterial isolates should be tested against all or nearly all of the antimicrobial agents within the antimicrobial categories and selective reporting and suppression of results should be avoided. © 2011 European Society of Clinical Microbiology and Infectious Diseases. No claim to original US government works.
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            Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group.

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            Invasive fungal diseases are important causes of morbidity and mortality. Clarity and uniformity in defining these infections are important factors in improving the quality of clinical studies. A standard set of definitions strengthens the consistency and reproducibility of such studies. After the introduction of the original European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group definitions, advances in diagnostic technology and the recognition of areas in need of improvement led to a revision of this document. The revision process started with a meeting of participants in 2003, to decide on the process and to draft the proposal. This was followed by several rounds of consultation until a final draft was approved in 2005. This was made available for 6 months to allow public comment, and then the manuscript was prepared and approved. The revised definitions retain the original classifications of "proven," "probable," and "possible" invasive fungal disease, but the definition of "probable" has been expanded, whereas the scope of the category "possible" has been diminished. The category of proven invasive fungal disease can apply to any patient, regardless of whether the patient is immunocompromised, whereas the probable and possible categories are proposed for immunocompromised patients only. These revised definitions of invasive fungal disease are intended to advance clinical and epidemiological research and may serve as a useful model for defining other infections in high-risk patients.
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              Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases.

              L. Munoz-Price, Laurent Poirel, Robert Bonomo … (2013)
              Klebsiella pneumoniae carbapenemases (KPCs) were originally identified in the USA in 1996. Since then, these versatile β-lactamases have spread internationally among Gram-negative bacteria, especially K pneumoniae, although their precise epidemiology is diverse across countries and regions. The mortality described among patients infected with organisms positive for KPC is high, perhaps as a result of the limited antibiotic options remaining (often colistin, tigecycline, or aminoglycosides). Triple drug combinations using colistin, tigecycline, and imipenem have recently been associated with improved survival among patients with bacteraemia. In this Review, we summarise the epidemiology of KPCs across continents, and discuss issues around detection, present antibiotic options and those in development, treatment outcome and mortality, and infection control. In view of the limitations of present treatments and the paucity of new drugs in the pipeline, infection control must be our primary defence for now. Copyright © 2013 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Infect Dis
                Journal ID (iso-abbrev): Clin Infect Dis
                Journal ID (publisher-id): cid
                Title: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
                Publisher: Oxford University Press (US )
                ISSN (Print): 1058-4838
                ISSN (Electronic): 1537-6591
                Publication date Collection: 01 October 2020
                Publication date (Electronic): 09 January 2020
                Publication date PMC-release: 09 January 2020
                Volume: 71
                Issue: 7
                Pages: e159-e169
                Affiliations
                [1 ] Transplant Infectious Diseases Unit, University Hospitals Geneva , Geneva, Switzerland
                [2 ] Clinic for Transplantation Immunology and Nephrology (Swiss Transplant Cohort Study), University Hospital of Basel , Basel, Switzerland
                [3 ] Transplantation and Clinical Virology, Department of Biomedicine, University of Basel , Basel, Switzerland
                [4 ] Infectious Diseases and Hospital Epidemiology, University Hospital Basel , Basel, Switzerland
                [5 ] Infectious Diseases Service and Transplantation Center, University Hospital and University of Lausanne , Lausanne, Switzerland
                [6 ] Institute of Microbiology and Infectious Diseases Service, University Hospital and Medical School , Lausanne, Switzerland
                [7 ] Department of Infectious Diseases, Bern University Hospital, University of Bern , Bern, Switzerland
                [8 ] Clinic of Internal Medicine and Infectious Diseases , Clinica Luganese, Lugano, Switzerland
                [9 ] Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen , St Gallen, Switzerland
                [10 ] Division of Infectious Diseases and Hospital Epidemiology and Children’s Research Center, University Children’s Hospital , Zürich, Switzerland
                [11 ] Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich , Zürich, Switzerland
                Author notes
                Correspondence: N. J. Mueller, University Hospital Zurich, Division of Infectious Diseases and Hospital Epidemiology, Rämistrasse 100/RAE U 70, Zürich CH-8091, Switzerland ( nicolas.mueller@ 123456usz.ch ).

                Active members of the Swiss Transplant Cohort Study are listed in the Appendix.

                Author information
                http://orcid.org/0000-0002-2642-419X
                Article
                Publisher ID: ciz1113
                DOI: 10.1093/cid/ciz1113
                PMC ID: 7583409
                PubMed ID: 31915816
                SO-VID: 89efadd9-49ac-4de1-890b-d6a83af50cd7
                Copyright © © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                Date received : 02 July 2019
                Date accepted : 11 November 2019
                Date: 05 November 2019
                Date: 09 January 2020
                Page count
                Pages: 12
                Funding
                Funded by: Swiss Transplant Cohort Study, DOI 10.13039/501100010455;
                Funded by: Swiss National Science Foundation, DOI 10.13039/501100001711;
                Funded by: Swiss University Hospitals;
                Categories
                Subject: Online Only Articles
                Subject: Articles
                Subject: AcademicSubjects/MED00290

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: infection,bacterial,fungal,viral,solid organ transplant
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: infection, bacterial, fungal, viral, solid organ transplant

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