Addenbrooke’s Hospital Rosie Hospital MICRO-ORGANISMS RESPONSIBLE FOR INFECTIONS AFTER...

Addenbrooke’s Hospital Rosie Hospital MICRO-ORGANISMS RESPONSIBLE FOR INFECTIONS AFTER INTESTINAL/MULTIVISCERAL TRANSPLANTATION AT ADDENBROOKE’S HOSPITAL, CAMBRIDGE, UK Introduction Infection is the most frequent cause of mortality in patients who have undergone intestinal and multivisceral transplantation 1 . The majority of patients experience at least one infective episode. Factors implicated include heavy immunosuppression, loss of mucosal barrier function and the presence of indwelling lines/catheters. Methods Micro-organisms associated with infective episodes occurring in 28 consecutive patients following transplantation at Addenbrooke’s, Cambridge University Hospital, UK, were identified from case notes and microbiological records. Infective episodes were defined as events leading to a clinical diagnosis of infection and the administration of antimicrobial agents, with the identification of likely causal microorganisms. Results In the first post-operative month, infecting organisms were isolated on 110 occasions, of these the most frequent were Enterococci, Pseudomonas, Coagulase-negative Staphylococci (CNS), Candida and Coliforms, respectively. In months 1-3, there were 22 isolates, most frequently Enterococcus, Pseudomonas, Klebsiella, Candida, and Stenotrophomonas. In months 3-6 isolates were obtained on 10 occasions, most frequently Cytomegalovirus (CMV), Pseudomonas, Candida, Mycobacterium and CNS. In months 6-12 31 isolates were identified, most frequently CMV, Pseudomonas, CNS, Enterococcus, non-candidal yeasts. During months 12-24, there were 49 isolates, most commonly CMV, Klebsiella, Enterococcus, Pseudomonas, Candida and after 24 months follow up there were 12 isolates, most commonly CMV, E.coli, Klebsiella, Enterococcus and Norovirus. E poster 470 Discussion Infection remains a significant clinical problem following intestinal/multivisceral transplantation. In the early months enteric organisms account for the majority of microbiological isolates. A second cluster of infections is seen after 6 months, the majority of these being CMV. Based on these findings we have altered our protocol, in particular, to reduce the use of early Vancomycin prophylaxis and to extend CMV prophylaxis to 1 year. References 1. Intestinal Transplant Registry bi-annual report. Intestinal Transplant Association. 2013 0 40 80 120 Month(s) post Transplant Number of isolates Figure 1: Number of isolates in each time period post transplant Chattopadhyay 1 , Tom Glover 1 , Rui Gao 2 , Krisztian Vegh 1 , Dunecan Massey 1 , Lisa Sharkey 1 , Bridget Ban tte Rutter 1 , Effrossyni Gkrania-Klostas 3 , Suzanne English 4 , Andrew Butler 5 , David Enoch 6 , Stephen M ussell 5 , Simon Gabe 8 ents of Gastroenterology 1 , Infectious Diseases 3 , Virology 4 , Transplant Surgery 5 , Microbiology 6 , Cambridge University ion Trust, Cambridge, UK . 2 Department of Gastroenterology, Luton and Dunstable NHS Trust, Luton, UK; 7 Department o h University Hospital, Plymouth, UK; 8 Intestinal Failure Unit, St Mark’s Hospital, London, UK [email protected] Importantly, in a few cases causal organisms were only identified post-mortem (including Mucor). An increasing prevalence of resistance is observed – in our institution over half of Enterococcus isolates are vancomycin resistant (VRE) and 60% of Pseudomonal isolates are resistant to carbapenems. In contrast, only 1 case of methicillin-resistant staphylcoccus aureus was seen.

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Transcript of Addenbrooke’s Hospital Rosie Hospital MICRO-ORGANISMS RESPONSIBLE FOR INFECTIONS AFTER...

Addenbrooke’s Hospital Rosie Hospital

MICRO-ORGANISMS RESPONSIBLE FOR INFECTIONS AFTER INTESTINAL/MULTIVISCERAL TRANSPLANTATION AT ADDENBROOKE’S HOSPITAL, CAMBRIDGE, UK

Introduction

Infection is the most frequent cause of mortality in patients who have undergone intestinal and multivisceral transplantation1. The majority of patients experience at least one infective episode. Factors implicated include heavy immunosuppression, loss of mucosal barrier function and the presence of indwelling lines/catheters.

Methods

Micro-organisms associated with infective episodes occurring in 28 consecutive patients following transplantation at Addenbrooke’s, Cambridge University Hospital, UK, were identified from case notes and microbiological records. Infective episodes were defined as events leading to a clinical diagnosis of infection and the administration of antimicrobial agents, with the identification of likely causal microorganisms.

Results

In the first post-operative month, infecting organisms were isolated on 110 occasions, of these the most frequent were Enterococci, Pseudomonas, Coagulase-negative Staphylococci (CNS), Candida and Coliforms, respectively.In months 1-3, there were 22 isolates, most frequently Enterococcus, Pseudomonas, Klebsiella, Candida, and Stenotrophomonas.In months 3-6 isolates were obtained on 10 occasions, most frequently Cytomegalovirus (CMV), Pseudomonas, Candida, Mycobacterium and CNS.In months 6-12 31 isolates were identified, most frequently CMV, Pseudomonas, CNS, Enterococcus, non-candidal yeasts.During months 12-24, there were 49 isolates, most commonly CMV, Klebsiella, Enterococcus, Pseudomonas, Candida and after 24 months follow up there were 12 isolates, most commonly CMV, E.coli, Klebsiella, Enterococcus and Norovirus.

E poster 470

DiscussionInfection remains a significant clinical problem following intestinal/multivisceral transplantation. In the early months enteric organisms account for the majority of microbiological isolates. A second cluster of infections is seen after 6 months, the majority of these being CMV.Based on these findings we have altered our protocol, in particular, to reduce the use of early Vancomycin prophylaxis and to extend CMV prophylaxis to 1 year.

References1. Intestinal Transplant Registry bi-annual report. Intestinal Transplant Association. 2013

1-3 1-3 3-6 6-12

12-24

>24

100

120

Month(s) post Transplant

iso

late

Figure 1: Number of isolates in each time period post transplant

Rahul Chattopadhyay1, Tom Glover1, Rui Gao2, Krisztian Vegh1, Dunecan Massey1, Lisa Sharkey1 , Bridget Bannerman1, Charlotte Rutter1, Effrossyni Gkrania-Klostas3, Suzanne English4, Andrew Butler5, David Enoch6, Stephen Middleton1,7, Neil Russell5, Simon Gabe8 Departments of Gastroenterology1, Infectious Diseases3, Virology4, Transplant Surgery5, Microbiology6, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK . 2Department of Gastroenterology, Luton and Dunstable NHS Trust, Luton, UK; 7Department of Gastroenterology, Plymouth University Hospital, Plymouth, UK; 8Intestinal Failure Unit, St Mark’s Hospital, London, [email protected]

Importantly, in a few cases causal organisms were only identified post-mortem (including Mucor).An increasing prevalence of resistance is observed – in our institution over half of Enterococcus isolates are vancomycin resistant (VRE) and 60% of Pseudomonal isolates are resistant to carbapenems. In contrast, only 1 case of methicillin-resistant staphylcoccus aureus was seen.