RESUMEN
Pseudomonas aeruginosa (PA) infections occurring after renal transplantation (RT) represent a potentially life-threatening complication. We present 2 cases of early death following RT in which PA was transmitted, possibly from the donor to the recipients, despite preoperative cultures that were negative. The donor had developed PA-related bilateral pneumonia while in the intensive care unit. However, after appropriate antibiotic therapy, no signs of infection were present at the time of organ retrieval and cultures were negative. Both recipients received a renal graft from the same donor and developed multi-drug resistant (MDR)-PA infections with bacterial phenotypes and resistances similar to the donor. The first recipient died 9 days after RT from rupture of a false aneurysm of the external iliac artery, caused by a fully thickened PA-related arteritis. The second recipient died postoperatively on day 10 after rupture of an aneurysm in the right vertebral artery. Our experience shows that MDR-PA infection early after RT may be a catastrophic event. Specific anti-PA antibiotic therapy in RT patients during the perioperative period is recommended in the case of PA infection in the donor, even after apparent successful therapy with negative cultures.
Asunto(s)
Arteritis/microbiología , Farmacorresistencia Bacteriana Múltiple , Hemorragia/etiología , Trasplante de Riñón/efectos adversos , Infecciones por Pseudomonas/complicaciones , Pseudomonas aeruginosa/efectos de los fármacos , Adulto , Aneurisma Roto , Antibacterianos/farmacología , Resultado Fatal , Femenino , Humanos , Arteria Ilíaca/microbiología , Masculino , Persona de Mediana Edad , Infecciones por Pseudomonas/microbiología , Pseudomonas aeruginosa/aislamiento & purificación , Arteria Vertebral/microbiologíaRESUMEN
Mycotic aneurysms on the branches of vertebro basilar artery are rare. A patient of infective endocarditis with mycotic aneurysm on the posterior cerebral artery is described. The aneurysm resolved with medical therapy. Controversies regarding the management of mycotic aneurysms are discussed.