A case of catheter-related bloodstream infection caused by Mycobacterium phocaicum

We present a patient with double hit Burkitt's like lymphoma who developed a catheter-related bloodstream infection due to Mycobacterium phocaicum that was identified by rpoB gene sequencing. His infection resolved with 7 weeks of antibiotics and port-a-cath removal

942. Pulmonary Infections in Intestinal Transplant Recipients with Preexisting Pulmonary Nodules

Abstract Background Pulmonary nodules in asymptomatic patients could represent latent pulmonary infections. Intestinal transplant (ITx) recipients with preexisting pulmonary nodules might be at higher risk for pulmonary infections. However, data is lacking. Methods This retrospective study included adult patients that underwent intestinal transplantation (ITx) from 5/2016 to 5/2020. Chest computed tomography (CT) scans performed within 12 months prior of ITx were obtained to evaluate for preexisting pulmonary nodules. Screening for endemic mycoses, Aspergillus, Cryptococcus and latent tuberculosis infection (LTBI) performed within 12 months prior ITx was obtained. We assessed for worsening pulmonary nodules, and fungal and mycobacterial infections during the 1st year post-transplant. Survival at one year post-transplant was also assessed. Results Forty-three patients underwent ITx. Twenty-three (53%) were Female. Median age was 46 years (range: 18-67). Chest CT scans were performed in 36(84%) patients prior to ITx. Preexisting pulmonary nodules were found in 30 (83%) of the patients. All were asymptomatic. Nodules were not calcified in 10 (33%) patients, calcified in 4 (13%), some calcified and some not calcified in 4 (13%) and unclear in 12 (40%). All the patients screened negative for fungi [Coccidioides antibody (Ab) was done in 15 (50%) patients, Blastomyces Ab and Histoplasma Ab in 7 (23%) each, Histoplasma urine antigen (Ag) and Aspergillus serum galactomannan in 3 (10%) each, and Cryptococcus serum Ag in 10 (33%) patients]. QuantiFERON-TB (QFT) was negative in 35 (81%) patients, positive in 2 (5%) and indeterminate in 6 patients (14%). QFT-Gold In-Tube was replaced to QFT-Plus in 3/2019. Post-transplant worsening of pulmonary nodules was noted in 12 (40%) patients and bronchoscopy was performed in six of them. Note that only 1 (3%) of the patients that had pre-existing pulmonary nodules developed a pulmonary infection (invasive pulmonary aspergillosis diagnosed 33 days after ITx). Our cohort survival at one year post-transplant was 79%. Conclusion Preexisting pulmonary nodules was common in our ITx cohort. However, only one case of pulmonary infection was noted among those who had preexisting pulmonary nodules. Clinical monitoring is essential. Disclosures All Authors: No reported disclosure

Investigation of inpatient probiotic use at an academic medical center

Despite the widespread use of probiotics, there are limited data regarding their safety. The aims of this study were to characterize inpatient probiotic use and to determine the incidence of probiotic-related bloodstream infections due to Lactobacillus acidophilus/Lactobacillus bulgaricus. This study was a two-part retrospective study conducted at a large academic medical center. The first part was the characterization of probiotic use during 2007-2008, which included the type of prescribing provider, choice of probiotic prescribed, indications for use, and presence of potential risk factors for probiotic infection among recipients; the second part was the determination of the incidence of probiotic-related bloodstream infections due to L. acidophilus/L. bulgaricus for September 2000-August 2008. Probiotic use was uncommon (0.4%). Ninety-six percent of patients received Lactobacillus-based compounds. Use was common in patients at theoretical risk for probiotic infection. The maximum estimated incidence of probiotic-related bacteremia due to L. acidophilus/L. bulgaricus during the 8-year period was 0.2%. L. acidophilus/L. bulgaricus probiotic use at our institution appeared to be associated with a minimal risk of probiotic-related infection, even though it was used at a high frequency among inpatients who could be considered at high theoretical risk for probiotic-related bloodstream infection

Infectious Complications After Liver Transplantation

Orthotopic liver transplantation (OLT) is the standard of care for patients with decompensated cirrhosis and for patients with hepatocellular carcinoma. More than 6000 liver transplants are performed annually in the United States. High patient and graft survival rates have been achieved in great part due to the availability of potent immunosuppressive agents. Systemic immunosuppression has rendered the liver recipient susceptible to de novo infections as well as reactivation of preexisting latent infections. Infections occurring during the first month post-OLT are usually nosocomial, donor-derived, or the result of a perioperative complication. The development of opportunistic infections (OIs) such as Aspergillus and the reactivation of latent infections such as Mycobacterium tuberculosis are more frequent 1 to 6 months posttransplant, when the net state of immunosuppression is the highest. Immunosuppressive therapy is tapered 6 to 12 months post-OLT; therefore, infections occurring during that time period and afterward generally resemble those of the general population. Screening strategies applied to determine the risk of an infection after transplantation and the use of prophylactic antimicrobial therapy have reduced the incidence of OIs after OLT. This article will review the various causes of infection post-OLT and the therapies used to manage complications