Tuberculosis in solid-organ transplant recipients: disease characteristics and outcomes in the current era.

We determined the characteristics of posttransplant tuberculosis and the impact of rifampin-based antituberculosis regimens on outcomes in the current era. Patients comprised 64 transplant recipients with tuberculosis, divided into 2 consecutive cohorts: an earlier cohort (cases occurring from 2003 to 2007) and a later cohort (cases from 2008 to 2011). Patients from the later versus earlier era had tuberculosis develop later after transplant (odds ratio, 1.01; 95% CI, 1.00-1.02; P= .05), were more likely to be liver transplant recipients (odds ratio, 4.52; 95% CI, 1.32-15.53; P= .02), and were more likely to receive tacrolimus-based immunosuppression (odds ratio, 3.24; 95% CI, 1.14-9.19; P= .03). Mortality rate was 10% in the later cohort and 21% in the earlier cohort (P= .20). Rifampin-based treatment was less likely to be used in patients with prior rejection (P= .04). However, neither rejection rate (P= .71) nor mortality (P= .93) after tuberculosis differed between recipients who received rifampin and recipients who did not. Thus, notable changes have occurred in the epidemiological characteristics of tuberculosis in transplant recipients. Overall mortality rate has improved, with about 90% of the patients now surviving after tuberculosis.

Emerging parasitic infections in transplantation.

This article concentrates on parasitic infections that are novel in solid organ transplantation for which there are meaningful data. It also addresses some issues that are either exceptional or a cause for new concern and where the evidence for a well-established recommendation is lacking.

Mycobacterium tuberculosis-associated immune reconstitution syndrome in solid-organ transplant recipients.

BACKGROUND: Incidence, characteristics, and risk factors for tuberculosis (TB)-associated immune reconstitution inflammatory syndrome (IRS) in solid-organ transplant (SOT) recipients are not known. METHODS: Patients are composed of 64 consecutive SOT recipients with TB followed for 12 months. IRS was defined based on previously proposed criteria. RESULTS: IRS developed in 14% (9/64) of the patients, a median of 47 days after the use of anti-TB therapy. Liver versus other types of organ transplant recipients (adjusted odds ratio [OR], 6.11; 95% confidence interval [CI], 1.08-34.86), prior cytomegalovirus infection (adjusted OR, 5.65; 95% CI, 0.93-34.47), and rifampin use (adjusted OR, 4.56; 95% CI, 0.74-27) were associated with a higher risk of IRS. The presence of more than one factor (liver transplantation, cytomegalovirus infection, and rifampin use) when compared with none of these factors conferred a 19-fold increase in the risk of IRS (P=0.01). Mortality at 1 year after diagnosis was 33.3% in patients with IRS and 17.2% in those without IRS (P=0.31). CONCLUSIONS: IRS was documented in 14% of the SOT recipients with TB. We determined clinically identifiable factors that may be useful in assessing the risk of tuberculosis-associated posttransplantation IRS.

Pandemic influenza A/H1N1 virus infection in solid organ transplant recipients: a multicenter study.

BACKGROUND: The 2009 novel influenza A/H1N1 virus pandemic did not spare solid organ transplant (SOT) recipients. We aimed to describe the behavior of pandemic influenza infection in a group of SOT recipients in Argentina. METHODS: Data from 10 transplant (Tx) centers were retrospectively collected for SOT that presented with a respiratory illness compatible with pandemic influenza A infection, between May and September 2009. Cases were defined as suspected, probable, or confirmed according to diagnostic method. RESULTS: Seventy-seven cases were included. No significant differences in presenting symptoms, pulmonary infiltrates, and graft involvement were found among 35 suspected, 19 probable, and 23 confirmed cases. The 33 ambulatory cases had significantly more sore throat and headache when compared with 34 cases admitted to medical ward (MW) and 10 admitted to intensive care unit (ICU), 9 of whom required ventilatory support. MW and ICU cases had significantly more dyspnea, hypoxemia, pulmonary infiltrates, and graft dysfunction. Time from onset of symptoms to first visit and to treatment was significantly longer in MW and ICU cases (P=0.008). Coinfections were found in six cases. Most cases received oseltamivir for 5 to 10 days. Six patients (7.8%) died from viral infection at a median of 15 days from admission. No differences in outcome were seen related to the transplanted organ, the immunosuppressive regimen, time from Tx, or confirmation of diagnosis. CONCLUSIONS: Mortality is higher in Tx recipients than in the general population. Poor outcome seems to be related to a delay in the beginning of treatment.

Brote epidémico por Staphylococcus aureus en un área quirúrgica / Staphylococcus aureus infection out-break in a general surgery ward

Ante un aumento llamativo de las infecciones de heridas quirúrgicas ocurrido em mayo de 1983 en la I Cátedra de Cirugía, se determinó que la incidencia de las mismas era 12% en heridas limpias y 33% en limpias contaminadas. El germen causal fue el S. aureus en el 50% de las primeras y en el 83% de las segundas. La tasa de infección en el cuatrimestre anterior (enero-abril 1983) fue 6,4% y 14% respectivamente. A mediados de mayo de 1983 se comenzó programa de control que incluyó búsqueda de portadores en el personal, tratamiento de los mismos, disminución de los días promedio de internación y énfasis en las medidas generales de prevención de las infecciones quirúrgicas. Se encontró un índice de portación nasal de 39,3% en médios y 31,4% en enfermeras y mucamas, que fueron tratados con cefalexina + rifampicina. Se disminuyeron los días promedio de internación de 10.67 a 7.50 (30%). La incidencia de infección de la herida quirúrgica en junio, julio y agosto fue para heridas limpias, 6,2%, 8,3% y 10% y de heridas limpias costaminadas 14%, 4,3% y 6%, habiéndose observado un solo caso de infección por S. aureus en junio y ninguno en los meses siguientes. Al realizar el análisis estadístico de las series cronológicas se observó un cambio de gradiente en la recta de tendencia coincidente con las medidas adoptadas para el control del problema. Se destaca la importancia de la detección precoz, del tratamiento de los portadores nasales y de la reducción del tiempo de internación

Evaluación del uso de los antibióticos en el Hospital de Clínicas "José de San Martín" / Evaluation of antibiotics use at the Hospital of Clinical José de San Martín

El 18 de junio de 1986 se efectuó en el Hospital de Clínicas José de San Martín un estudio para evaluar el uso de los antibióticos en pacientes internados y los gastos que surgen de su empleo inadecuado. El 28% de los internados recibían antibióticos, el 69% de las indicaciones con finalidad terapéutica y el 35% de las profilaxisis fueron correctas. El error más frecuente en el tratamiento fue el uso del antibiótico no electivo y en la profilaxis, la utilización innecesaria. El gasto por uso inadecuado fue de u$s 494.17 en un día, u$s 14.825 en un mes y u$s 180.372 por año