RESUMO
Transplant recipients are at increased risk of tuberculosis (TB). We describe a case of pulmonary and vertebral multidrug-resistant TB (MDR-TB) in a kidney transplant patient who required neurosurgical intervention and unfortunately developed fatal nosocomial complications. Thirteen transplant recipients with MDR-TB were previously reported in the literature (one hematopoietic cell transplant, one heart transplant, one lung transplant, one heart-lung transplant, and nine kidney transplant recipients). Extrapulmonary disease, severe treatment complications, and deaths were observed in patients who developed MDR-TB after transplantation.
Assuntos
Antituberculosos/uso terapêutico , Mycobacterium tuberculosis/fisiologia , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose da Coluna Vertebral/tratamento farmacológico , Adulto , Antituberculosos/farmacologia , Infecção Hospitalar/complicações , Infecção Hospitalar/microbiologia , Nefropatias Diabéticas/complicações , Farmacorresistência Bacteriana Múltipla , Evolução Fatal , Transplante de Células-Tronco Hematopoéticas , Humanos , Falência Renal Crônica/cirurgia , Transplante de Rim/efeitos adversos , Imageamento por Ressonância Magnética , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Procedimentos Neurocirúrgicos , Pneumonia Bacteriana/microbiologia , Reação em Cadeia da Polimerase , Insuficiência Respiratória/etiologia , Choque Séptico/microbiologia , Transplantados , Tuberculose Resistente a Múltiplos Medicamentos/complicações , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/cirurgia , Tuberculose Pulmonar/diagnóstico , Tuberculose da Coluna Vertebral/complicações , Tuberculose da Coluna Vertebral/diagnóstico , Tuberculose da Coluna Vertebral/cirurgiaRESUMO
During August 4-September 1, 2015, eight cases of Verona integron-encoded metallo-beta-lactamase (VIM)-producing Carbapenem-resistant Enterobacteriaceae (CRE) colonization were identified in six patients, using weekly active surveillance perirectal cultures in a Kentucky tertiary care hospital. No cases of clinical infection or complications attributable to colonization were reported. Four of the eight isolates were identified as Enterobacter cloacae; other organisms included Raoultella species (one), Escherichia coli (one), and Klebsiella pneumoniae (two). Six isolates were reported in a neonatal intensive care unit (ICU), and two isolates in an adult trauma and surgical ICU. Patient ages at isolate culture date ranged from 21 days to 68 years. Fifty percent of the patients were male. Previously, only one VIM-producing CRE-colonized patient (an adult, in 2013) had been reported by the same hospital. The six cases are the largest occurrence of VIM-producing CRE colonization reported in the United States and the only recognized cluster of VIM-producing CRE colonization in the United States reported to include a neonatal population. Despite environmental sampling over the same period, surveying patients for exposure to health care outside the United States, surveying health care providers for risk factors, and surveillance culturing of health care provider nares and axillae, a source of VIM-producing CRE has not been identified for this cluster. Prevention measures throughout the ICUs have been enhanced in response to this cluster, as detailed in CDC's 2015 CRE toolkit update.