Donor-derived vancomycin-resistant enterococci transmission and bloodstream infection after intestinal transplantation

Antimicrobial Resistance & Infection Control

Jens G. Brockmann¹  Felix Becker¹  Alexander Mellmann²  Carlos L. Correa-Martínez²  Vera Schwierzeck²  Stefanie Kampmeier³ 

[1] Department of General, Visceral and Transplant Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany;Institute of Hygiene, University Hospital Münster, Robert-Koch-Straße 41, 48149, Münster, Germany;Institute of Hygiene, University Hospital Münster, Robert-Koch-Straße 41, 48149, Münster, Germany;Institute of Medical Microbiology, University Hospital Münster, Domgakstraße 10, 48149, Münster, Germany;

关键词: Multidrug-resistant organisms;    Vancomycin-resistant enterococci;    Transplantation;    Donor-derived infection;    Whole genome sequencing;    Bloodstream infection;   

DOI  :  10.1186/s13756-020-00845-z

来源: Springer

【 摘 要 】

BackgroundTransplant recipients are at high risk for infections. However, donor-recipient transmission of multidrug-resistant organisms (MDROs) remains mostly unaddressed in the protocols of pre-transplant infection and colonization screening. Vancomycin-resistant enterococci (VRE) are MDROs that colonize the gastrointestinal tract and are associated with a significant burden of disease. Besides the high mortality of invasive VRE infections, chronic colonization leads to costly isolation measures in the hospital setting. Whereas most post-transplantation VRE infections are endogenous and thus preceded by colonization of the recipient, conclusive evidence of VRE transmission via allograft in the context of intestinal transplantation is lacking.Case presentationWe describe a donor-derived VRE infection after intestinal transplantation including small bowel and right hemicolon. The recipient, a 54-year old male with history of mesenteric ischemia and small bowel perforation due to generalized atherosclerosis and chronic stenosis of the celiac trunk and the superior mesenteric artery, developed an intra-abdominal infection and bloodstream infection after transplantation. VRE isolates recovered from the patient as well as from the allograft prior to transplantation were analyzed via whole genome sequencing. Isolates showed to be genetically identical, thus confirming the transmission from donor to recipient.ConclusionsThis case underlines the relevance of donor-recipient VRE transmission and invasive infection in the context of intestinal transplantation, highlighting the need for preoperative MDRO screening that facilitates the prompt and effective treatment of possible infections as well as the timely establishment of contact precautions to prevent further spread.

【 授权许可】

CC BY