Risk factors of invasive fungal infections in liver transplant recipients: A systematic review and meta-analysis.

Invasive fungal infections (IFIs) remain one of the most common infectious complications after organ transplantation, and liver transplant recipients (LTRs) have the highest mortality rate. However, risk factors associated with IFIs have only been evaluated in small single-center studies. We performed a meta-analysis by conducting a comprehensive search using Ovid MEDLINE, Ovid Embase, Cochrane database of systematic reviews, and Cochrane central register of controlled trials. All case-control and cohort studies evaluating risk factors for IFIs in adult LTRs were screened. Utilizing a random-effects model, a multivariate analysis was completed, and 28 studies were eligible for meta-analysis. Rates of IFIs ranged from 1.4% to 32.7%. Previous antibiotic use (OR 9.3; 95% CI 3.2-27.0) and bacterial infection (OR 4.3; 95% CI 2.1-8.6) were risk factors of invasive candidiasis. Yet for invasive aspergillosis, posttransplant renal replacement therapy (OR 9.2; 95% CI 4.2-20.4), reoperation (OR 8.0; 95% CI 2.9-21.7), and cytomegalovirus infection (OR 6.2; 95% CI 2.0-19.3) were risk factors. The top independent risk factors for IFIs during studies from 2010 to 2019 were previous fungal colonization (OR 9.19; 95% CI 4.92-17.16), reoperation (OR 5.45; 95% CI 2.93-10.15), and previous bacterial infections (OR 3.81; 95% CI 2.13-6.83). These risk factors may be targeted by antifungal prophylaxis in LTRs.

Mycobacterium mucogenicum and Mycobacterium neoaurum bacteremia in immunocompromised hosts.

Background: Mycobacterium mucogenicum and Mycobacterium neoaurum are infrequent causes of bacteremia in humans. When they are isolated from blood, it is not unusual for them to initially be considered contaminants. Methods: A retrospective chart review of patients diagnosed with M. mucogenicum and M. neoaurum bacteremia from January 1998 to December 2018 was conducted at the University Health Network, Toronto, Ontario, Canada. Results: We identified 28 patients who had bacteremia caused by these organisms. These patients were primarily immunocompromised, had chronically indwelling vascular access devices, or used intravenous drugs. For 29% of the patients, the isolation of these mycobacteria was considered colonization, whereas 82% of the patients received antimicrobial therapy and 95% had the central line removed. Conclusions: The removal of the vascular access device and treatment with either single or combination antimicrobial therapy produced successful outcomes for people with these infections.

Historique: Le Mycobacterium mucogenicum et le Mycobacterium neoaurum sont des causes peu fréquentes de bactériémie chez les humains. Lorsqu'ils sont isolés dans le sang, il n'est pas rare qu'ils soient d'abord considérés comme des contaminants. Méthodologie: Les chercheurs ont effectué une analyse rétrospective des dossiers de patients ayant reçu un diagnostic de bactériémie à M. mucogenicum ou à M. neoaurum entre janvier 1998 et décembre 2018 au Réseau de santé universitaire de Toronto, en Ontario, au Canada. Résultats: Les chercheurs ont repéré 28 patients atteints d'une bactériémie causée par ces organismes. Il s'agissait surtout de patients immunodéprimés, de patients munis d'une sonde à demeure ou d'utilisateurs de drogues par voie intraveineuse. Chez 29 % des patients, les mycobactéries isolées étaient considérées comme des colonisations, mais 82 % des patients ont reçu un traitement antimicrobien, et le cathéter central a été retiré chez 95 % d'entre eux. Conclusions: Le retrait du dispositif d'accès vasculaire et le traitement au moyen d'un ou de plusieurs antimicrobiens ont donné de bons résultats chez les personnes atteintes de ces infections.