Empiric vs screening-based use of isoniazid for tuberculosis prophylaxis: Safety and effectiveness in lung transplant recipients in Saudi Arabia.

BACKGROUND: Tuberculosis (TB) is a major complication following transplantation. The likelihood of TB may be increased in transplant patients living in TB-endemic areas such as Saudi Arabia. In areas where TB is less common, guidelines recommend isoniazid (INH) for TB prophylaxis depending on patient and donor screening results. However, in TB-endemic regions, studies have supported its use in all transplant patients regardless of TB screening results. This study aimed to compare the safety and effectiveness of administering INH prophylaxis therapy based on the TB screening results of lung transplant (LT) recipients. METHODS: We conducted a single-center retrospective cohort study on LT recipients. The outcomes were compared between patients who were administered screening-based prophylaxis (SBP) with INH based on their tuberculin skin tests (TSTs) or QuantiFERON results and those who were administered empirical prophylaxis (EP) with INH regardless of TB screening results. The primary endpoint was the incidence of TB infection, and the secondary endpoints were INH-induced hepatotoxicity and INH resistance. RESULTS: A total of 50 patients received SBP and 30 received EP. TB incidences were 8% and 0%, respectively (P = .0487). One of these patients had INH resistance, and one patient experienced INH-induced hepatotoxicity (P = .1591); both were in the SBP group. CONCLUSION: The low rates of TB infection, INH-induced hepatotoxicity, and INH resistance in the EP group suggest that INH prophylaxis appears to prevent TB and can be safely used in all LT recipients. However, prospective studies using large sample sizes are required to confirm these findings.

Peritoneal dialysis related infections in a tertiary care hospital in Riyadh, Saudi Arabia.

OBJECTIVES: To detect the incidence of and risk factors for infections among patients with end-stage renal disease (ESRD) undergoing peritoneal dialysis (PD). METHODS: A retrospective cohort study was conducted at the PD unit of King Fahad Medical City. End-stage renal disease patients above the age of 12 years who were undergoing PD management between January 2006 and March 2016 were included. RESULTS: One hundred PD patients were enrolled in the study and examined over a total observation period of 2,553 patient-months. The leading ESRD etiology was hypertension (26.3%). The mean duration of PD was 28.05 months. A total of 45 patients developed 101 episodes of technique-related infections (TRIs). Peritonitis represented the majority of these episodes (90 episodes), with an overall rate of one episode per 28.3 patient-months. TRIs were mostly caused by coagulase-negative staphylococci. A total of 12 patients developed non-technique related infections (NTRIs). There was a statistically significant difference between patients with TRI and non-infected patients regarding the presence of diabetes and duration of dialysis. No peritonitis-related deaths were noted. In total, 21 patients continued on PD and 18 patients were shifted to hemodialysis (HD). Conclusion: In our setting, ESRD patients undergoing PD are more susceptible to TRIs than NTRIs. Diabetes increases the risk of developing TRIs. The high incidence of coagulase-negative staphylococcal TRI suggests touch contamination.