Fiebre e infección en el paciente trasplantado de órgano sólido: recomendaciones clínicas en diferentes contextos

Introducción El trasplante es un procedimiento coste-eficaz que supone la salvación la vida de miles de pacientes, y que mejora claramente su calidad de vida. A lo largo de la historia, ha habido que realizar miles de intentos fallidos hasta el año 1954 cuando tiene lugar el primer trasplante renal con éxito total entre dos pacientes gemelos univitelinos en la Universidad de Harvard de Boston. Desde entonces hasta nuestros días se han producido grandes avances en la técnica quirúrgica y el manejo posterior de los pacientes con trasplante de órgano sólido. Actualmente, España se sitúa como líder mundial tanto de donación de órganos como en trasplantes realizados. Durante el proceso de donación-trasplante, el médico especialista continúa enfrentándose a diferentes retos y nuevas dificultades en el manejo del paciente con trasplante. Durante el periodo previo a la cirugía, se requieren potenciar una correcta relación médico-paciente, establecer un buen programa educacional y completar un régimen de visitas ambulatorias para el cribado diagnóstico. Posteriormente al trasplante los principales condicionantes en el pronóstico del paciente con TOS son los episodios de infección y el rechazo del órgano..

Characterizing carbapenemase-producing Escherichia coli isolates from Spain: high genetic heterogeneity and wide geographical spread

IntroductionCarbapenemase-Producing Escherichia coli (CP-Eco) isolates, though less prevalent than other CP-Enterobacterales, have the capacity to rapidly disseminate antibiotic resistance genes (ARGs) and cause serious difficult-to-treat infections. The aim of this study is phenotypically and genotypically characterizing CP-Eco isolates collected from Spain to better understand their resistance mechanisms and population structure.MethodsNinety representative isolates received from 2015 to 2020 from 25 provinces and 59 hospitals Spanish hospitals were included. Antibiotic susceptibility was determined according to EUCAST guidelines and whole-genome sequencing was performed. Antibiotic resistance and virulence-associated genes, phylogeny and population structure, and carbapenemase genes-carrying plasmids were analyzed.Results and discussionThe 90 CP-Eco isolates were highly polyclonal, where the most prevalent was ST131, detected in 14 (15.6%) of the isolates. The carbapenemase genes detected were blaOXA-48 (45.6%), blaVIM-1 (23.3%), blaNDM-1 (7.8%), blaKPC-3 (6.7%), and blaNDM-5 (6.7%). Forty (44.4%) were resistant to 6 or more antibiotic groups and the most active antibiotics were colistin (98.9%), plazomicin (92.2%) and cefiderocol (92.2%). Four of the seven cefiderocol-resistant isolates belonged to ST167 and six harbored blaNDM. Five of the plazomicin-resistant isolates harbored rmt. IncL plasmids were the most frequent (45.7%) and eight of these harbored blaVIM-1. blaOXA-48 was found in IncF plasmids in eight isolates. Metallo-β-lactamases were more frequent in isolates with resistance to six or more antibiotic groups, with their genes often present on the same plasmid/integron. ST131 isolates were associated with sat and pap virulence genes. This study highlights the genetic versatility of CP-Eco and its potential to disseminate ARGs and cause community and nosocomial infections