1 / 28

Gram-Negative Infections in Solid Organ Transplantation

Gram-Negative Infections in Solid Organ Transplantation. Murat Akova, MD, FESCMID Hacettepe University School of Medicine Department of Infectious Diseases Ankara, Turkey. WHO 2017. Classification ß-Lactamases. Class Active site Examples Substrates

sinclair
Download Presentation

Gram-Negative Infections in Solid Organ Transplantation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Gram-Negative Infections in Solid Organ Transplantation Murat Akova, MD, FESCMID Hacettepe University School of Medicine Department of InfectiousDiseases Ankara, Turkey

  2. WHO 2017

  3. Classification ß-Lactamases Class Active site Examples Substrates ASerineTEM, SHV,CTX-M Penicillins, 3rd GCs KPC All beta-lactams B Zn++ IMP, VIM, NDM All beta-lactams, not monobactams C SerineAmp C Cephamycins, 3rd GCs D Serine OXA All beta-lactams Ambler, RP. Philos Trans R Soc Lond B Biol Sci1980;289:321

  4. CTX-M Encoding Plasmid Woodford N, et al. AAC 2009; 53:4472

  5. Global Epidemiology of CTX-M Enzymes Bewan ER, et al. J Antimicrob Chemother 2017;72:2145

  6. Carbapenemases in Enterobacteriaceae KPC NDM OXA-48 VIM Courtesy of DM Livermore

  7. Epidemiology of KPC-Kp Lee C-R, et al. Frontiers Microbiol 2016;7:895

  8. Epidemiology of OXA-48 Producers Bonomo RA, et al. Clin Infect Dis 2018;66:1290

  9. Epidemiology of NDM Producers Bonomo RA, et al. Clin Infect Dis 2018;66:1290

  10. Antibiotic Consumption and Resistance Collignan P, et al. PLoS One 2015;10:e116746

  11. Control of Corruption and Resistance Collignan P, et al. PLoSOne 2015;10:e116746

  12. Collignon P, et al. Lancet Planet Health 2018;2:e398

  13. Resistance Corruption Infrastructure Collignon P, et al. Lancet Planet Health 2018;2:e398

  14. Parameters Related with Antibiotic Resistance • Increased resistance • Poor infrastructure (Poor santiation) • Bad governance (Corruption) • Low health expenditure • Privatization in health sector • Higher GDP per capita • High education index • Decreased resistance • Urbanization, internet and electiricty access • Socialized health services • No relationship or undetermined • Antibiotic use • Climate Collignon P, et al. Lancet Planet Health 2018;2:e398

  15. Quinolone 3rd gen. cephalosporin Collignon P, et al. Lancet Planet Health 2018;2:e398

  16. Gram (-)ve InfectionsKidney Transplantation • Recurrent UTI • Structural abnormalities • Renal cyst infection • Surgical site infection • Perigraft infected hematoma • ESBL (+) E. coli • 12% of all infections • 70% UTI • CR-K. pneumoniae • P. aeruginosa • UTI, HAP • A. baumannii • 3% bacteremia • VAP Aguado JM, et al. Transplant Rev 2018;32:36

  17. Gram (-)ve InfectionsLiver Transplantation Silva TS, te al. Curr Opin Infect Dis 2018;31:499 Intraabdominal abscesses Intraabdominal infected hematomas Tertiary peritonitis Infected biliomas Cholangitis R Recurrent biliary infection

  18. MDR Gram (-)ve InfectionsLiver Transplantation • Usually early post-tx (12-24 days) • ESBL (+) Enterobacteriaceae • 5.5%-7.0%, mainly by E. coli and K. pneumoniae • Carbapenem-R Enterobacteriaceae (CRE) • 6.0%-12.9% • x 5 mortality as compared to CSE • Mostly intraabdominal infections, HAP, UTI Aguado JM, et al. Transplant Rev 2018;32:36

  19. MDR Phenotype in Bacteremia in Liver Tx Shi SH, et al. Transpl Infect Dis 2009;11:405 Rana MM, etal. Transpl Infect Dis2013;15:E157 In general >50% in certain series A. baumannii 62.5% Enterobacteriaceae 54.8% S. maltophilia 54.2% P. aeruginosa 51.5%

  20. Gram (-)ve InfectionsHeart Transplantation • Pneumonia during the 1st month post-tx • MDR P. aeruginosa • Carbapenem-R A. baumannii (CRAB) • MDR S. maltophilia • Associated bacteremia is frequent • Mediastinitis and sternal SSI • 2.5% • ESBL E. coli and non-fermenters Aguado JM, et al. Transplant Rev 2018;32:36

  21. Gram (-)ve InfectionsLungTransplantation • P. aeruginosa in cystic fibrosis • Pre-tx colonization >50% • Leading cause of HAP, 25% of cases • Bronchiolitis obliterans , bronchovascular fistula • CRAB • HAP, UTI, catheter associated BSI • Burkholderia cepacia • Chronic lung infections, mediastinitis/abscesses • <50% MDR Aguado JM, et al. Transplant Rev 2018;32:36

  22. Guideline Recommendations on MDR Gram (-)ves Bartoletti M, te al. Infect Dis Clin N Am 2018;32:551

  23. Donor Acceptance with MDR-GN Bartoletti M, te al. Infect Dis Clin N Am 2018;32:551

  24. Antibiotic Prophylaxis Bartoletti M, te al. Infect Dis Clin N Am 2018;32:551

  25. Conclusions • MDR Gram-negatives have a significant impact on SOT recipients • Several issues remain uncertain • Selection of recipients • Screening • Prophylaxis • Infection control • Treatment

  26. Thank you…

More Related