Editor's Choice - Validation of the Management of Aortic Graft Infection Collaboration (MAGIC) Criteria for the Diagnosis of Vascular Graft/Endograft Infection: Results from the Prospective Vascular Graft Cohort Study.

OBJECTIVE: The timely management of vascular graft/endograft infection (VGEI) is crucial to a favourable outcome, yet can be challenging as there is no validated gold standard diagnostic test. Recently, a new case definition has been proposed by the Management of Aortic Graft Infection Collaboration (MAGIC) to close the diagnostic gap. The aim of this study was to validate the MAGIC criteria as a suggested diagnostic standard for the diagnosis of suspected VGEI in the prospective Vascular Graft Cohort study (VASGRA). METHODS: VASGRA is an open, prospective, observational cohort study. Prospective participants in VASGRA between 2013 and 2019 were included (257 patients; 137 with VGEI). The accuracy of the MAGIC criteria for a diagnosis of VGEI was evaluated retrospectively by calculating the sensitivity and specificity vs. the consensually adjudicated VASGRA infection status. RESULTS: The VASGRA cohort categorised 137 (53.3%) patients as "diseased" and 120 patients as "not diseased"; using the MAGIC criteria, 183/257 (71.2%) patients were considered to be "diseased". Thus, for the MAGIC criteria, a sensitivity of 99% (95% confidence interval [CI] 96-100) and a specificity of 61% (95% CI 52-70) were calculated. Considering suspected VGEI according to the MAGIC criteria as "not diseased" achieved congruent assessments of the VASGRA team and the MAGIC criteria, with a sensitivity of 93% and a specificity of 93%. The accuracy of the MAGIC criteria for the different graft locations were also compared. If the suspected VGEIs were assigned to the "not diseased" group, VGEIs of the thoracic aorta seemed to have a poorer sensitivity (86%; 95% CI 73-95) than the other graft locations. CONCLUSION: The current MAGIC criteria offer good sensitivity and specificity in the context of true infections but a reduced specificity for a possible VGEI.

The effect of gamma and microwave radiation sterilization on periodontological grafts for microbiological evaluation.

Periodontological grafts are materials used in dentistry to regenerate lost gingival soft tissues or bone parts. In the case of direct contact with blood, the possibility of disease transmission from the source to the patient is high. This source can be an animal or a human. Therefore, the sterilization of grafts before implanting to the patient is of significant importance. The purpose of this study was to evaluate gamma radiation and microwave sterilization processes from microbiological and sterility perspectives and to compare the effectiveness of these two sterilization methods. Grafts were irradiated with 2, 4, 5, 10, 25 and 50 kGy doses of gamma radiation. Another group of same materials was irradiated by microwave for 1, 2, 3 and 4 min at 24,500 MHz and 900 W. Gamma radiation and microwave sterilization methods were evaluated as successful at minimum doses as 5 kGy and 3 min, respectively. Both gamma and microwave sterilization successfu lly sterilized periodontological grafts coded as PBG1, HBG1, HL1, PDG1, MBG3, MDG2 and PDG3. Moreover, microwave sterilization can be used as an alternative novel method to gamma radiation sterilization.

Abdominal Aortic Graft Infection Caused by stG485.0, ST29 Streptococcus dysgalactiae subsp. equisimilis.

In recent years, the prevalence of invasive Streptococcus dysgalactiae subsp. equisimilis (SDSE) infections has increased gradually throughout the world, including Japan. Here, we report the case of an abdominal aortic graft infection caused by stG485.0, ST29 SDSE in an elderly patient with diabetes. The patient was an 86-year-old man who had undergone surgery 10 years ago for treating a non-infected abdominal aortic aneurysm using a bifurcated graft. He was referred to our hospital after being suspected of having an abdominal aortic graft infection based on computed tomography (CT) scans. He underwent surgery to drain the pus that had accumulated between the aneurysm and graft. Although blood cultures were negative, the surgical specimen culture was positive for a ß-hemolytic group G streptococci, which was subsequently identified as SDSE using 16S ribosomal RNA sequencing. Genetic relationships deduced from emm and multilocus sequence typing revealed the isolate to be types stG485.0 and ST29, respectively. Although aortic aneurysm graft infection has a poor prognosis, we successfully rescued the patient through prompt surgery and identification of the responsible pathogen. This case indicates that attention must be paid toward possible SDSE infections in the field of vascular surgery.

Encuesta sobre el manejo de injertos del ligamento cruzado anterior contaminados accidentalmente / Survey on management of accidentally contaminated anterior cruciate ligament grafts

OBJETIVO: Encuestar a cirujanos de rodilla en Chile, sobre su conducta en contaminaciones accidentales del injerto, en reconstrucciones de ligamento cruzado anterior (LCA). MÉTODOS: Se realizó una encuesta anónima en relación a la incidencia, tratamiento y resultados clínicos de los injertos de LCA contaminados, a todos los médicos pertenecientes al área de traumatología y ortopedia asistentes al congreso Ateneo de rodilla 2015. RESULTADOS: Se encuestaron 54 médicos, 33 (61%) especialistas en cirugía de rodilla y 21 (39%) médicos en formación. De los cirujanos de rodilla, 15 (45%) reportaron al menos un caso de contaminación, de los cuales 12 (80%) informaron un único evento, 3 (20%) indicaron la eventualidad en 2, 3 y 5 ocasiones respectivamente, para un total de 22 injertos contaminados. De los cirujanos que reportaron injertos contaminados, 11 (73%) realizan 50 o más reconstrucciones al año. La decisión tomada en los casos de contaminación fue en 13 oportunidades (59%), lavar el injerto y utilizarlo de acuerdo al plan inicial; en 6 casos (27%), utilizar aloinjerto; en 2 ocasiones (9%), utilizar autoinjerto alternativo; y en 1 oportunidad (5%); triplicar el semitendinoso. Ninguno de los casos de contaminación reportó infecciones. CONCLUSIONES: En casos de una contaminación accidental, la mayoría de los cirujanos encuestados prefieren optar por la descontaminación del injerto y su utilización en la reconstrucción de acuerdo al plan inicial; para lo cual la clorhexidina y antibióticos sería la solución a usar de preferencia. NIVEL DE EVIDENCIA: Nivel V, opinión de experto.

OBJECTIVE: To survey knee surgeons who perform anterior cruciate ligament (ACL) reconstruction in Chile, about the management when ACL graft contamination occurs. METHODS: An anonymous survey was conducted to all physicians belonging to the area of traumatology and orthopedics who attended the 2015 annual Chilean Knee Society meeting. The survey questioned the incidence, treatment, and outcomes of ACL graft contaminations. RESULTS: Fifty-four physicians were surveyed, of which 33 (61%) where knee surgeons and 21 (39%) physicians in training. Of the 33 knee surgeons, 15 (45%) reported at least one contamination during their career. Of those 15, 12 (80%) had one event, and three surgeons (20%) informed having 2, 3, and 5 episodes respectively, for a total of 22 reported contaminated grafts. Of the surgeons who reported a contaminated graft, 11 (73%) performed 50 or more ACL reconstructions annually. In 13 opportunities (59%) the management for a contaminated graft was cleansing the graft and proceeding as planned. In 6 cases (27%) an allograft was used, in 2 occasions (9%) a different graft was harvested, and in 1 opportunity (5%) a semitendinosus graft triplication was performed. No infections in any of the contaminated grafts were reported. CONCLUSIONS: In case of accidental graft contamination during an ACL reconstruction, knee surgeons most often preferred disinfecting the graft and using it as the initial plan. LEVEL OF EVIDENCE: Level V, expert opinion.

Glomerulonephritis triggered by chronical aortic graft infection in a male with Loeys-Dietz syndrome: A case report.

RATIONALE: Glomerulonephritis triggered by a chronically infected graft is increasingly identified because of widely used implanted device. Removal of the aortic graft and sustained antibiotic therapy is the usual approach to maximize the chance of renal recovery, but as this case shows graft removal is not always possible. PATIENT CONCERNS: A 35-year-old man with intractable and recurrent fever had acute renal failure in sustained antibiotic therapy. DIAGNOSES: Renal biopsy suggested crescentic glomerulonephritis. fluorodeoxyglucose/positron emission tomography-computed tomography showed increased metabolic activity at the site of aortic graft, reminding that chronic infection of an implanted graft can lead to severe glomerulonephritis. TGFBR2 c.1133G>T mutation was observed in mutation analysis, which was reported to be associated with Loeys-Dietz syndrome. INTERVENTIONS: Although infection was properly controlled with appropriate antimicrobial treatment, his renal dysfunction did not improve. A short-term inclusion of low-dose corticosteroid significantly benefit without introducing harm. OUTCOMES: He partly recovered from renal injury. LESSONS: In patients with glomerulonephritis triggered by a long-duration infection, low-dose corticosteroid therapy may be considered when renal dysfunction secondary to nephritis does not improve after appropriate antimicrobial treatment.

A reliable method to avoid contamination during cartilage graft preparation in septorhinoplasty.

PURPOSE: The aim of the study is to determine the risk of contamination in the cartilage graft materials prepared on the swester table and those prepared in a sterile package, and to reveal a more reliable method by performing the microbiological examination of these materials. METHODS: Cartilages removed from the nasal septum were divided into four pieces. The first part (Sample A) was directly placed into the medium. Sample B was prepared by being crushed in a sterile package. Sample C was prepared on the auxiliary swester table, and Sample D was prepared on the main swester table actively used by surgery team. All samples were transferred in a 1 ml brain heart(BH) liquid medium. From each BH medium, 100 µl culture was performed on blood agar, eosin-methylene blue-lactose-sucrose agar and chocolate agar. RESULTS: Bacterial growth was detected in 2 of the samples A, in 4 of the samples B, in 24 of the samples C, and in 36 of the samples D. The number of patients with bacterial growth in the samples C and/or D despite no growth in the sample B was 35. When the samples A/B and C/D were compared in terms of bacterial growth, a significant difference was found in all matchings (p < 0.001 for all comparisons).  CONCLUSION: These findings showed that preparation of the cartilage grafts on the swester table was extremely risky for microbiological contamination. Arslan and his colleagues suggest that preparing a graft material in a sterile package is extremely simple, cheap, and it also reduces contamination risk significantly.

Fatal Fusarium infection manifesting as osteomyelitis following previous treatment with amphotericin B in a multi-visceral transplant: Case report and review of Fusarium infections in solid organ transplantation.

Invasive fusariosis in solid organ transplant is uncommon and usually presents as localized infection with favorable outcomes compared to hematologic malignancies or bone marrow transplants. We report the first case of Fusarium osteomyelitis in a patient following multi-visceral transplant and review Fusarium in organ transplant recipients and Fusarium bone and joint infections. Our case underscores the importance of early recognition and multidisciplinary approach to treatment and highlights potential failure to eradicate with amphotericin B monotherapy.

Contamination occurs during ACL graft harvesting and manipulation, but it can be easily eradicated.

PURPOSE: Why anterior cruciate ligament (ACL) autograft soaking in a 5 mg/ml vancomycin solution decreases the rate of infection has not been well-explained. One hypothesis is that grafts can be contaminated during harvesting and vancomycin eradicates the bacteria. The purpose of the present study is to assess how the vancomycin solution acts against ACL graft contamination during graft harvesting and preparation. METHODS: The study was carried out in three university hospitals over a period of 6 months. After sample size calculation, 50 patients were included in the study. Three samples were taken from each ACL graft. Sample 1 was obtained immediately after graft harvesting. After graft manipulation and preparation, the remaining tissue was divided into two parts. The raw sample was denominated sample 2 and sample 3 consisted of the rest of the remaining tissue that had been soaked in the vancomycin solution. All the cultures were incubated at 37 °C with 5% CO2 in agar plates for 7 days (aerobically) or 14 days (anaerobically) and inspected daily for microbial growth. Any bacterial growth and the number of colony forming units were reported. RESULTS: In seven cases (14%), either sample 1 or sample 2 was positive. In five of the cases (10%), only the sample after graft preparation was positive (sample 2). In two cases (4%), sample 1 and sample 2 were positive for the same bacteria. Isolated microorganisms corresponded to coagulase-negative staphylococci (CNS) and Propionibacterium acnes. No bacterial growth was observed in sample 3 (p < 0.001). Thus, none of those seven positive cases (0%) were positive after vancomycin soaking (p < 0.001). CONCLUSION: In the series, ACL graft harvesting and manipulation leads to bacterial contamination in 14% of the cases. This contamination is fully eradicated after soaking in the vancomycin solution in this series. LEVEL OF EVIDENCE: Level II.

Intestinal microbiota changes after solid organ transplantation: a systematic review

Introduction: The intestinal microbiota may undergo changes after solid organ transplantation. The purpose of this systematic review was to characterize the intestinal microbiota of patients undergoing solid organ transplantation. Methods: MEDLINE, EMBASE and Cochrane Library databases were searched from inception to July 21, 2017. Studies of patients undergoing solid organ transplantation that evaluated changes in intestinal microbiota composition and one of the following outcomes were included: post-transplant weight, new-onset diabetes after transplantation, delayed graft function, acute rejection, graft and patient survival, and post-transplant infections. Results: Out of 765 studies found in this search, two studies (86 patients) fulfilled inclusion criteria. Both studies assessed kidney transplantation recipients, and a reduction in bacterial species diversity after transplantation was observed. Changes in intestinal microbiota were associated with acute rejection in both studies. One study reported diarrhea and urinary infections, while the other one reported urinary and respiratory infections. None of them reported other outcomes of interest. Conclusion: Changes in intestinal microbiota were observed after kidney transplantation, and they were associated with higher incidence of acute rejection and infections in transplant recipients. However, data are still scarce and more studies are needed to evaluate if microbiota changes have an impact on post-transplant outcomes. (AU)

Vascular Graft Infection: Incidence and Potential Risk Factors.

PURPOSE: The purpose of this study was to identify factors that increase the risk of vascular graft infections (VGI) in patients following abdominal or lower extremity revascularization surgery. DESIGN: Retrospective, descriptive study. METHODS: We reviewed the electronic health records of 223 patients who had undergone abdominal or lower extremity revascularization procedures from July 2012 to November 2014, looking for factors associated with VGI. We reviewed 28 preoperative, intraoperative, and post-operative factors. Descriptive statistics (mean, range, and standard deviation) were used to describe the sample; χ was used to determine correlations between the risk factors and subsequent VGIs. The level of significance was determined at P = .05, with a confidence level of 95%. RESULTS: We identified 33 cases of VGIs for the 223 charts reviewed, yielding an incidence rate of 15%. Seventeen of the 33 patients with VGI (51.5%) were male. The average age of patients who experienced VGI was 60.9 years (standard deviation, 12.2 years, range, 29-81 years). Preoperative factors that were shown to show statistical significance for the development of VGI were sequential procedures (P = .003), diabetes mellitus (P = .002), hemoglobin A1c more than 7.0 (P = .0002), blood glucose more than 180 mg/dL (P = .0006), and lack of mobility (0.0097). Intraoperative factors associated with VGI were hemostatic agents applied to the surgical field intraoperatively (P = .003) and perioperative hypoxemia (P = .027). Postoperative factors associated with VGI were discharge from the hospital to skilled nursing facility or acute rehabilitation facility (P = .005) and unscheduled clinic visits (P = .008). CONCLUSION: We measured a 15% incidence of VGI and identified multiple pre-, intra-, and postoperative associated factors. Vigilance is required to prevent VGI and knowledge of specific risk factors is important.

Validation of microbiological testing in cardiovascular tissue banks: results of a quality round trial.

OBJECTIVES: Surgeons needing human cardiovascular tissue for implantation in their patients are confronted with cardiovascular tissue banks that use different methods to identify and decontaminate micro-organisms. To elucidate these differences, we compared the quality of processing methods in 20 tissue banks and 1 reference laboratory. We did this to validate the results for accepting or rejecting tissue. We included the decontamination methods used and the influence of antibiotic cocktails and residues with results and controls. The minor details of the processes were not included. METHODS: To compare the outcomes of microbiological testing and decontamination methods of heart valve allografts in cardiovascular tissue banks, an international quality round was organized. Twenty cardiovascular tissue banks participated in this quality round. The quality round method was validated first and consisted of sending purposely contaminated human heart valve tissue samples with known micro-organisms to the participants. The participants identified the micro-organisms using their local decontamination methods. RESULTS: Seventeen of the 20 participants correctly identified the micro-organisms; if these samples were heart valves to be released for implantation, 3 of the 20 participants would have decided to accept their result for release. Decontamination was shown not to be effective in 13 tissue banks because of growth of the organisms after decontamination. Articles in the literature revealed that antibiotics are effective at 36°C and not, or less so, at 2-8°C. The decontamination procedure, if it is validated, will ensure that the tissue contains no known micro-organisms. CONCLUSIONS: This study demonstrates that the quality round method of sending contaminated tissues and assessing the results of the microbiological cultures is an effective way of validating the processes of tissue banks. Only when harmonization, based on validated methods, has been achieved, will surgeons be able to fully rely on the methods used and have confidence in the consistent sterility of the tissue grafts. Tissue banks should validate their methods so that all stakeholders can trust the outcomes.

Graft infection after a Bentall procedure: A case series and systematic review of the literature.

INTRODUCTION: The Bentall procedure is a cardiac surgery involving graft replacement of the aortic valve, aortic root and ascending aorta. Graft infection after Bentall's procedure (BGI) is infrequent but severe, and often difficult to diagnose and treat. PATIENTS AND METHODS: A retrospective cohort study was performed using the Bordeaux endocarditis database of adult patients admitted to the Bordeaux University Medical Hospital for BGI between 2008 and 2014. Published case reports were identified in the literature. RESULTS: We identified 10 BGI patients in the database and 13 in the literature. The majority of infections were late-onset (20/23) and occurred as a result of gram positive cocci bacterial infection (16/22). Detailed diagnoses of the described BGI were determined using echocardiography, computed tomography (CT) and positron emission tomography/CT (PET/CT). Labeled-leukocyte scintigraphy was not reported in any case. Prolonged antibiotic therapy and surgery were found to be the treatment of choice for BGI; however it was not always possible to perform a surgical intervention. Clinical relapses occurred even with a negative PET/CT, while PET/CT consistently positive for BGI occurred in the absence of clinical relapse. This suggests that the use of PET/CT for follow-up is questionable. CONCLUSION: Diagnosis of BGI is difficult, due to the combination of clinical, biological, and radiological observations obtained through transesophageal echocardiography and CT. PET/CT is an alternative method to diagnosis BGI, but its impact on clinical management remains unclear. Current data suggests that if surgical replacement of the prosthesis is not possible, patients should be treated with prolonged antibiotic therapy.

The effects of ozone on bacterial growth and thiol-disulphide homeostasis in vascular graft infection caused by MRSA in rats

Abstract: Purpose: To investigate the microbiological, inflammatory and oxidant effects of adjuvant ozone administration in experimental rat vascular graft infection model which has not been previously investigated. Methods: Forty adult Wistar rats were divided into Sham, Control, Vancomycin, Ozone, Vancomycin+Ozone groups. Grafts were inoculated with Methicillin-resistant Staphylococcus aureus (MRSA) strain and implanted subcutaneously. Rats were treated intraperitoneally with ozone and /or intramuscularly with vancomycin for 10 days. Grafts were evaluated by quantitative bacterial cultures. Blood samples were harvested for determination of thiol-disulphide and cytokine profiles. Results: There was no significant difference in bacterial counts between Control and Ozone Groups. In the Ozone Group median colony count was significantly higher than the Vancomycin and Vancomycin+Ozone Groups. Total thiol and disulphide levels increased and disulphide/native thiol and disulphide/total thiol ratios decreased in Ozone Group significantly. Albumin levels decreased significantly in Vancomycin and Vancomycin+Ozone Groups compared to the Sham Group. IL-1 and TNF-alpha levels significantly increased in infected rats. Decreased levels of VEGF due to infection reversed by ozone therapy in control and vancomycin groups. Conclusions: We didn't observe any benefit of the agent on MRSA elimination in our model. Likewise, effects of ozone on thiol-disulphide homeostasis and inflammatory cytokines were contradictory.

Recurrent Clostridium difficile infection treated with home fecal transplantation: a case report.

INTRODUCTION: Clostridium difficile infection causes severe diarrhea, abdominal pain and weight loss. A course of metronidazole is the initial treatment; however up to 40% of patients have at least one recurrence. Some patients have recurrent infections requiring further treatment with vancomycin, others need multiple courses of expensive treatment. Fecal transplantation has been proposed as an effective treatment option for patients with recurrences. We report the case of a patient with recurrent Clostridium difficile infection unresponsive to usual treatment and her experience with home fecal transplantation. CASE PRESENTATION: A 66-year-old Canadian Caucasian woman presented to her family doctor in December 2012 with a 10-day history of explosive watery diarrhea. She was diagnosed with Clostridium difficile infection and treated with metronidazole. Diarrhea recurred and despite treatment with vancomycin and finally, fidaxomicin, she continued to have recurrent Clostridium difficile infection over the following four months. A formal fecal transplantation program was not available in her home province; therefore home fecal transplantation was performed under supervision by her family physician. This was the first case of fecal transplantation performed in the province and was done outside of a hospital setting. She recovered immediately and has been well for the past year since the procedure. CONCLUSIONS: Home fecal transplantation by rectal enema is a viable, safe and practical option for patients with recurrent Clostridium difficile infection. It is less costly and uses fewer resources than traditional delivery methods through nasogastric tube, upper endoscopy or colonoscopy. Patients and their families and donors need medical supervision through the process of screening, telephone availability during the procedure and medical follow-up. This can be done by family physicians without the need for expensive hospital care and subsequent follow-up.

An anti-infection tissue-engineered construct delivering vancomycin: its evaluation in a goat model of femur defect.

A tissue-engineered construct (TEC) has previously been used for treating bone defects due to its strong osteogenic capability. However, transplantation of a TEC involves an open surgery that can cause infection. To overcome the potential risk of infection after TEC transplantation, we designed a system for the controlled release of antibiotics using fibrin gel-coated vancomycin alginate beads (FG-Vanco-AB) that can supply sustained antibiotics at the graft site. A TEC with FG-Vanco-AB was transplanted into critically sized bone defects of the right femur in a goat. As a control, the TEC without FG-Vanco-AB was transplanted into the left femur defect of the same goat. The breakpoint sensitivity of vancomycin for S. aureus (5 mg/L) was used as a known standard. Study results showed that the duration of time with vancomycin concentrations greater than 5 mg/L in the right graft site, blood, and left graft site were 28 days, 7 days, and 2 days, respectively. The bioactivity regarding vancomycin release was analysed by antibiotic disc diffusion. The vancomycin concentration was decreased from the centre of the graft to both ends of the femur. Radionuclide bone imaging showed no significant difference between the right and left TECs at either 28 or 56 days post-operation. Computed tomography and histological observation showed both sides' bone defects were healed by TEC at 112 days post-operation, and there was no significant difference in computed tomography value. These results suggest that FG-Vanco-AB in transplanted bone provided the ability to kill bacteria in local bone tissue while not interfering with the process of bone reconstruction and wound healing.

The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement.

Tuberculosis (TB) is a possible complication of solid organ and hematopoietic stem cell transplantation. The identification of candidates for preventive chemotherapy is an effective intervention to protect transplant recipients with latent infection with Mycobacterium tuberculosis from progressing to active disease. The best available proxy for diagnosing latent infection with M. tuberculosis is the identification of an adaptive immune response by the tuberculin skin test or an interferon-γ based ex vivo assay. Risk assessment in transplant recipients for the development of TB depends on, among other factors, the locally expected underlying prevalence of infection with M. tuberculosis in the target population. In areas of high prevalence, preventive chemotherapy for all transplant recipients may be justified without immunodiagnostic testing while in areas of medium and low prevalence, preventive chemotherapy should only be offered to candidates with positive M. tuberculosis-specific immune responses. The diagnosis of TB in transplant recipients can be challenging. Treatment of TB is often difficult due to substantial interactions between anti-TB drugs and immunosuppressive medications. This management guideline summarises current knowledge on the prevention, diagnosis and treatment of TB related to solid organ and hematopoietic stem cell transplantation and provides an expert consensus on questions where scientific evidence is still lacking.

Fungal culture of musculoskeletal tissue: what's the point?

There have not been any studies that review the prevalence of fungal isolates using selective media from samples of banked musculoskeletal tissue retrieved from living and cadaveric donors. A total of 2,036 swab and 2,621 biopsy samples of musculoskeletal tissue from tissue banks were received from the 1st August 2008 till 31st December 2010. Routine culture for fungi using selective media with a prolonged incubation period failed to demonstrate a greater prevalence of fungal isolates than by using non-selective culture media alone. Using selective culture fungi were recovered from only two Sabouraud agar plates (0.1%) but not from non-selective media. During the same period fungi were isolated from three graft samples cultured in non-selective broth media only (0.1%). There was no correlation of fungal isolates from selective or non-selective media inoculated at the same time nor from multiple graft samples collected from the same donor supporting the possibility of an exogenous source for fungal isolates rather than an endogenous source.

Participation of strictly anerobic bacteria in infections among hospitalized transplant patients in a clinical hospital in Warsaw.

BACKGROUND: Many strictly anerobic bacteria are a part of the human commensal microflora. Especially multitudinously they inhabit the skin, mucous membranes, gastrointestinal tract, respiratory, and genital tracts. Infections with these bacteria may occur after escape of the bacteria from their natural habitat. There are often mixed anerobic and aerobic infections. After rupture of the gastrointestinal tract or surgery, the organisms can cause significant pathology including abscesses and bacteremia. OBJECTIVE: The aim of this study was to estimate the prevalence of gram-negative strictly anerobic bacteria isolated from different samples collected from patients on transplant wards. MATERIALS AND METHODS: Samples from patients with suspected infections. Underwent isolation and identification of microorganisms under anerobic conditions using standard laboratory methods. RESULTS: Gram-negative rods were observed in 46% of clinical samples, most frequently Bacteroides genus as well as Fusobacterium necrophorum/F.nucleatum and F.mortiferum (14%). Most species of the genus Bacteroides were accompanied by Escherichia coli, less frequently with other aerobic gram-negative rods or gram-positive cocci. CONCLUSION: Gram-negative bacteria were frequently isolated in the samples. Because they are the part of the normal flora, this observation indicated the endogenous nature of infections resulting from bacterial translocation out of their natural habitat.

Diagnosis and treatment of fungal infections in allogeneic stem cell and solid organ transplant recipients.

IMPORTANCE OF THE FIELD: Invasive fungal diseases (IFD) are severe complications in patients receiving immunosuppression after solid organ or allogeneic stem cell transplantation. Extensive study has been conducted on therapeutic strategies for IFD in neutropenic patients, mostly those with hematological malignancy. There is an ongoing discussion on whether these studies may be applied to transplant patients as well. AREAS COVERED IN THIS REVIEW: We have reviewed relevant literature on transplantation and clinical mycology of the last 20 years and selected articles relevant for today's treatment decisions. This article reports on the epidemiology of IFD in transplant recipients and current antifungal drugs in the context of tansplantation medicine. For invasive aspergillosis and invasive candidiasis, we give a detailed report of current clinical evidence. WHAT THE READER WILL GAIN: This review is intended as a quick-start for clinicians and other care providers new to transplant care and as an update for experienced transplant physicians. In a field in which evidence is scarce and conflicting, we provide evidence-based strategies for diagnosing and treating the most relevant IFD in transplant recipients. TAKE HOME MESSAGE: Physicians treating transplant patients should maintain a high level of awareness towards IFD. They should know the local epidemiology of IFD to make the optimal decision between current diagnostic and therapeutic strategies. Prophylaxis or early treatment should be considered given the high mortality of IFD.

Trichosporon asahii as a prospective pathogen in solid organ transplant recipients.

Trichosporon spp. is not an important factor of mycotic infections in immunocompetent patients. It may be a cause of invasive mycoses with a high mortality rate in patients undergoing solid organ transplantation. We have analysed the antifungal agents' susceptibility of Trichosporon asahii and its frequency of occurrence as a prospective etiological agent of infections in liver, kidney and simultaneous pancreas-kidney transplant recipients. Clinical specimens (urine, blood, peritoneal fluid and swabs) were obtained from patients hospitalised in the Institute of Transplantation Medicine, Department of General and Transplantation Surgery, Medical University of Warsaw in 2005 and 2006. Microbiological tests were performed in Mycological Laboratory, Department of Microbiology, Medical University of Warsaw. A total of 475 strains of yeast-like fungi were isolated from clinical specimens taken from 263 liver, kidney and simultaneous pancreas-kidney transplant recipients and from 26 organ donors. Trichosporon asahii was found in 26 clinical samples taken from 18 patients and one organ donor. Positive cultures were obtained from 22 urine samples, one stoma fluid, one wound swab, one tracheal aspirate and one ejaculate. Isolates of Trichosporon asahii were found in 6% of total positive mycological cultures in the solid organ transplant recipients. Among cultured strains, 11 isolates were resistant to fluconazole, four to itraconazole and three of them demonstrated resistance to amphotericin B.