Evaluation of Microvascular Complications in Kidney Recipients with Post-Transplant Diabetes Mellitus.

CONTEXT: Limited data on microvascular complications in patients with post-transplant diabetes (PTDM) is an obstacle to developing follow-up algorithms. OBJECTIVES: To evaluate diabetic microvascular complications in patients with long-standing PTDM. METHODS: This study included patients with at least a five-year history of PTDM and age-matched renal transplant recipients without PTDM (NDM). Diabetic peripheral neuropathy (PN) was evaluated using the Michigan Neuropathy Screening Instrument (MNSI), the CASE IV device, and in vivo corneal confocal microscopy (CCM). Cardiac autonomic neuropathy (CAN) tests were performed using the heart rate variability. Nephropathy (DN) screening was assessed using spot urine albumin/creatinine ratio and eGFR calculation. Diabetic retinopathy (DR) was evaluated by fundus examination and photography, and optical coherence tomography. RESULTS: This study included 41 patients with PTDM and 45 patients in the NDM group. The median follow-up was 107.5 months in the PTDM group. PN was significantly higher in the PTDM group than in the NDM group (p = 0.02). In the PTDM patients with PN, the corneal nerve fiber density examined by CCM was significantly lower than in the PTDM patients without neuropathy (p = 0.001). Parasympathetic involvement was observed in 58.5% of the PTDM group and 22% of the NDM group (p = 0.001). Sympathetic involvement was present in 65.9% of the PTDM group and 29.3% of the NDM group (p = 0.001). Retinopathy was observed in 19.5% of patients in the PTDM group, while none were in NDM patients (p < 0.001). Renal functions were similar between the study groups. CONCLUSIONS: CAN and DR can affect patients with PTDM at a high rate. DR was found to be a threat to the vision of PTDM patients. Diabetic PN can be detected early in PTDM patients by CCM.

Cessation of Rectal Screening for Vancomycin-Resistant Enterococci: Experience from a Tertiary Care Hospital from Türkiye.

OBJECTIVE: Here, we compared the impact of different polices on the epidemiology of Vancomycin-resistant Enterococcus faecium bloodstream infections (VRE-BSIs) in a tertiary care hospital including two hospital buildings (oncology and adult hospitals) in the same campus. MATERIAL AND METHODS: All patients who were hospitalized in high-risk units were screened weekly for VRE colonization via rectal swab between January 2006 and January 2013. After January 2013, VRE screening was only performed in cases of suspicion of VRE outbreak and during point prevalence studies to evaluate the epidemiology of VRE colonization. Contact precautions were in place for all VRE-positive patients. The incidence density rates of hospital-acquired (HA)-VRE-BSIs were compared between two periods. RESULTS: While the rate of VRE colonization was higher in the second period (5% vs. 9.5% (p < 0.01) for the adult hospital, and 6.4% vs. 12% (p = 0.02 for the oncology hospital), there was no increase in the incidence rate HA-VRE BSIs after the cessation of routine rectal screening in either of the hospitals. CONCLUSION: Screening policies should be dynamic and individualized according to the epidemiology of VRE as well as the workforce and cost. Periodical rectal screening of VRE can be discontinued if suspicion of an outbreak can be carefully monitored.