Bacteremia During the First Year After Solid Organ Transplantation: An Epidemiological Update.

BACKGROUND There are limited contemporary data on the epidemiology and outcomes of bacteremia in solid organ transplant recipients (SOTr). METHODS Using the Swiss Transplant Cohort Study registry from 2008 to 2019, we performed a retrospective nested multicenter cohort study to describe the epidemiology of bacteremia in SOTr during the first year post-transplant. RESULTS Of 4383 patients, 415 (9.5%) with 557 cases of bacteremia due to 627 pathogens were identified. One-year incidence was 9.5%, 12.8%, 11.4%, 9.8%, 8.3%, and 5.9% for all, heart, liver, lung, kidney, and kidney-pancreas SOTr, respectively (P = .003). Incidence decreased during the study period (hazard ratio, 0.66; P < .001). One-year incidence due to gram-negative bacilli (GNB), gram-positive cocci (GPC), and gram-positive bacilli (GPB) was 5.62%, 2.81%, and 0.23%, respectively. Seven (of 28, 25%) Staphylococcus aureus isolates were methicillin-resistant, 2/67 (3%) enterococci were vancomycin-resistant, and 32/250 (12.8%) GNB produced extended-spectrum beta-lactamases. Risk factors for bacteremia within 1 year post-transplant included age, diabetes, cardiopulmonary diseases, surgical/medical post-transplant complications, rejection, and fungal infections. Predictors for bacteremia during the first 30 days post-transplant included surgical post-transplant complications, rejection, deceased donor, and liver and lung transplantation. Transplantation in 2014-2019, CMV donor-negative/recipient-negative serology, and cotrimoxazole Pneumocystis prophylaxis were protective against bacteremia. Thirty-day mortality in SOTr with bacteremia was 3% and did not differ by SOT type. CONCLUSIONS Almost 1/10 SOTr may develop bacteremia during the first year post-transplant associated with low mortality. Lower bacteremia rates have been observed since 2014 and in patients receiving cotrimoxazole prophylaxis. Variabilities in incidence, timing, and pathogen of bacteremia across different SOT types may be used to tailor prophylactic and clinical approaches

Monitoring and Forecasting COVID-19: Statistical Heuristic Regression, Susceptible-Infected-Removed model and, Spatial Stochastics

The COVID-19 pandemic has had worldwide devastating effects on human lives, highlighting the need for tools to predict its development. Dynamics of such public-health threats can often be efficiently analysed through simple models that help to make quantitative timely policy decisions. We benchmark a minimal version of a Susceptible-Infected-Removed model for infectious diseases (SIR) coupled with a simple least-squares Statistical Heuristic Regression (SHR) based on a lognormal distribution. We derived the three free parameters for both models in several cases and tested them against the amount of data needed to bring accuracy in predictions. The SHR model is approximately +/- 2% accurate about 20 days past the second inflexion point in the daily curve of cases, while the SIR model reaches a similar accuracy a fortnight before. All the analyzed cases assert the utility of SHR and SIR approximants as a useful tool to forecast the evolution of the disease. Finally, we have studied simulated stochastic individual-based SIR dynamics, which yields a detailed spatial and temporal view of the disease that cannot be given by SIR or SHR methods.Comment: 33 pages, 14 figures, 3 table

Surgical site infections after kidney transplantation are independently associated with graft loss.

Surgical site infections (SSI) are common healthcare-associated infections. SSIs after kidney transplantation (K-Tx) can endanger patient and allograft survival. Multicenter studies on this early post-transplant complication are scarce. We analyzed consecutive adult K-Tx recipients enrolled in the Swiss Transplant Cohort Study (STCS) that received a K-tx between May 2008 and September 2020. All data were prospectively collected with the exception of the categorization of SSI that was performed retrospectively according to the Centers for Disease Control and Prevention criteria. A total of 58 out of 3059 (1.9%) K-Tx recipients were affected by SSIs. Deep incisional (15, 25.9%) and organ/space infections (34, 58.6%) predominated. In the majority of SSIs (52, 89.6%) bacteria were detected, most frequently Escherichia coli (15, 28.9%), Enterococcus spp. (14, 26.9%), and coagulase-negative staphylococci (13, 25.0%). A BMI ≥25kg/m2 (multivariable OR 2.16, 95% CI 1.07-4.34, P=0.023) and delayed graft function (multivariable OR 2.88, 95% CI 1.56-5.34, P=0.001) were independent risk factors for SSI. In Cox proportional hazard models, SSI was independently associated with graft loss (multivariable HR 3.75, 95% CI 1.35-10.38, P=0.011). In conclusion, SSI was a rare complication after K-Tx. BMI ≥25kg/m2 and delayed graft function were independent risk factors. SSI were independently associated with graft loss