Successful Kidney Transplantation after COVID-19

COVID-19, the ongoing pandemic caused by SARS-CoV-2, has had a dramatic impact on transplant systems in the most affected countries, namely Italy. Preliminary data indicates that patients on hemodialysis therapy as well kidney transplant (KTx) recipients appear to be particularly susceptible to COVID-19 illness due to immunosuppression and coexisting conditions. Currently, there is a lack of data concerning the biologic behavior, recurrence and long-term morbidity of COVID-19 and there are no experiences of transplants in patients who have previously had COVID-19. We report what is likely to be the first case of a KTx performed after a recent COVID-19 illness

Fatal Donor-Derived Carbapenem-Resistant Klebsiella pneumoniae Infection in a Combined Kidney-Pancreas Transplantation

Carbapenem-resistant Klebsiella pneumoniae (CR-KP) infections in solid organ transplant recipients are associated with high morbidity and mortality. We report a case of a fatal donor-derived CR-KP infection in a combined kidney-pancreas transplant. Given the short interval of time between donor hospitalization and organ procurement, information concerning the donor CR-KP positivity arrived only 72 hours after transplant. Based on this experience, we believe that knowledge of the donor’s CR-KP status should be mandatory before procurement and, if positive, pancreas donation should be contraindicated

Thyrotoxic storm during sepsis: study of a rare complication, clinical and biological observations

We describe an uncommon severe clinical complication of sepsis – thyrotoxic storm (TS). Common biologic, pathogenic, clinical conditions that can determine sepsis can cause a TS. High circulating values of vascular cellular adhesive molecules-1 and various pro-inflammatory citochines are related with thyroid damage. During sepsis, moderate dysfunctions are not expression of actual disease, but severe damage in pituitary-thyroid hormonal axis. Thyroid stimulated hormon release, and consequent overproduction of thyroid hormones can cause TS. In critical patients, presence of hormonal dysfunctions determines more elevated clinical score of sepsis severity and higher risk of death than control groups (without thyroid disease) or survived patients

Unusual Extrapulmonary Rhodococcus Equi Infection in a Kidney Transplant Patient

Rhodococcus equi is a well-recognized pathogen in veterinary medicine that can also affect immuno-compromised human subjects. The most common clinical features in humans include necrotizing pneumonia with subacute pulmonary disease, progressive cough, chest pain and fever. We report a case of a 49-year-old kidney transplant patient who developed a Rhodococcus equi infection characterized by multiple abscesses of the soft tissues and muscles without any respiratory manifestation. Combining specific antibiotic therapy and surgical management of the abscesses without immunosuppression discontinuation led to a complete recovery of both patient and graft

Carbapenem-resistant Klebsiella pneumoniae (CR-KP) infections in kidney transplantation

BACKGROUND: Carbapenem-resistant Klebsiella pneumoniae (CR-KP) infections in solid organ transplant patients are progressively increasing and are associated with worse outcomes, although potential risk factors and therapeutic strategies are still not well defined. METHODS: We conducted a retrospective matched-pair analysis in which we compared 26 recipients CR-KP-positive after kidney transplantation (KT) with 52 CR-KP-negative patients transplanted in the same period, during a CR-KP outbreak that occurred in our hospital. Twenty-one patients (80%) received a combined antibiotic treatment. At the end of the follow-up, of the 26 CR-KP infected patients, 11 (42.3%) experienced at least one episode of re-infection, 9 (34.6%) remained colonized, and 6 (23.0%) had a symptomatic infection. Two of the 11 patients with re-infection died, while 9 were colonized at the end of the study. RESULTS: A significantly better patient (P = .043) and graft (P < .001) survival was observed in CR-KP-negative patients. Univariate analysis identified the following variables as potential risk factors associated with CR-KP infection after KT: lower body mass index (P = .020); higher creatinine levels at post-transplant days 7 (P = .009), 15 (P = .026), and 30 (P = .019); longer hospital stay (P = .007); longer cold ischemia time (P = .004); delayed graft function (P = .020); and higher Clavien-Dindo score (P = .006). CONCLUSION: The study confirmed that a CR-KP positivity may affect the outcome of a kidney transplant population. In severe CR-KP infections with sepsis, a combined antibiotic treatment seems to be advisable

Diagnostic and therapeutic appropriateness in bone and joint infections: results of a national survey

27noThe impact of infectious diseases (ID) specialist consultation in the management of many types of bacterial infections has been fully demonstrated but not for bone and joint infections (BJIs). Nineteen ID Italian centres collected of data from June 2009 to May 2012. Italian guidelines (2009) were used to determine the appropriateness of the diagnostic and therapeutic process of BJIs before and after consulting an ID specialist. Data on 311 patients were collected: 111 cases of prosthetic joint infection, 99 osteomyelitis, 64 spondylodiscitis and 37 fixation device infection. A significant increase of microbiological investigations, imaging techniques and blood inflammation markers were noted after consulting the ID specialist. Moreover, inappropriateness of treatment duration, dosage, and number of administrations significantly decreased after consultation. Infectious disease specialist intervention in the management of BJIs significantly increases the appropriateness both in performing instrumental and laboratory analysis, but especially in determining the correct therapy.nonenoneEsposito, Silvano; Russo, Enrico; De Simone, Giuseppe; Gioia, Renato; Petta, Ester; Leone, Sebastiano; Noviello, Silvana; Artioli, Stefania; Ascione, Tiziana; Bartoloni, Alessandro; Bassetti, Matteo; Bertelli, Davide; Boccia, Giovanni; Borrè, Silvio; Brugnaro, Pierluigi; Caramello, Pietro; Coen, Massimo; Crisalli, Maria Paola; De Caro, Francesco; Dodi, Ferdinando; Fantoni, Massimo; Foti, Giuseppe; Giacometti, Andrea; Leoncini, Francesco; Libanore, Marco; Migliore, Simona; Venditti, MarioEsposito, Silvano; Russo, Enrico; De Simone, Giuseppe; Gioia, Renato; Petta, Ester; Leone, Sebastiano; Noviello, Silvana; Artioli, Stefania; Ascione, Tiziana; Bartoloni, Alessandro; Bassetti, Matteo; Bertelli, Davide; Boccia, Giovanni; Borrè, Silvio; Brugnaro, Pierluigi; Caramello, Pietro; Coen, Massimo; Crisalli, Maria Paola; De Caro, Francesco; Dodi, Ferdinando; Fantoni, Massimo; Foti, Giuseppe; Giacometti, Andrea; Leoncini, Francesco; Libanore, Marco; Migliore, Simona; Venditti, Mari

Correction to: Impact of a mixed educational and semi-restrictive antimicrobial stewardship project in a large teaching hospital in Northern Italy (Infection, 10.1007/s15010-017-1063-7)

A technical error led to incorrect rendering of the author group in this article. The correct authorship is as follows: Daniele Roberto Giacobbe1, Valerio Del Bono1, Malgorzata Mikulska1, Giulia Gustinetti1, Anna Marchese2, Federica Mina3, Alessio Signori4, Andrea Orsi5, Fulvio Rudello6, Cristiano Alicino5, Beatrice Bonalumi3, Alessandra Morando7, Giancarlo Icardi5, Sabrina Beltramini3, Claudio Viscoli1; On behalf of the San Martino Antimicrobial Stewardship Group

Infectious complications in liver transplant recipients in Italy: Logistic and research projects Complicanze infettive nel trapianto di fegato in Italia: Stato attuale e prospettive di studio

The impact of infections in orthotopic liver transplantation (OLT) is remarkable. Studies have shown that about 60% of patient may develop at least 1 infectious episode during the first 3 months after transplant. Within the frame of a Finalized Research Project of the Italian Ministry of Health, during the year 2000 a group of investigators belonging to the major Italian Liver Transplant Centers (LTC) - 18 out of 20 Centers - met three times in Genoa with the aim of constituting a Research Group aimed at improving our knowledge of infectious complications in liver transplant recipients (PITF = Program of Infections in Liver Transplantation). The group first collected information about anti-infective procedure in LTC. The study shows that no Center is supported by a Intensive Care Unit (ICU) exclusively dedicated to the LTC, although 37% of them have a partially dedicated Unit. Surveillance cultures are routinely performed and are frequently used to adress the choice of the antibacterial and antifungal regimes. Selective Bowel Decontamination is also very common. The management of CMV infection is usually performed as indicated in international guidelines

Tocilizumab and steroid treatment in patients with COVID-19 pneumonia

Coronavirus disease 2019 (COVID-19) can lead to respiratory failure due to severe immune response. Treatment targeting this immune response might be beneficial but there is limited evidence on its efficacy. The aim of this study was to determine if early treatment of patients with COVID-19 pneumonia with tocilizumab and/or steroids was associated with better outcome