Department of Surgery, Division of Transplantation, University of Virginia Health System, Charlottesville, Virginia, USA.
Surg Infect (Larchmt). 2012 Apr;13(2):114-20. doi: 10.1089/sur.2010.018.
Plesiomonas shigelloides is a freshwater, non-fermentative gram-negative bacillus associated with diarrheal disease. Rare cases of invasive infection in human beings usually involve immunosuppressed individuals.
We report a patient who underwent successful liver transplantation (LT) using a graft from a 14-year-old boy who had drowned in a freshwater lake. PUBMED was searched for both reported drowning victims with sepsis and outcomes of LT using organs from infected donors.
Our patient received prophylactic piperacillin-tazobactam, which was switched to cefepime one day after transplantation when gram-negative bacteria grew in blood cultures of the donor. The next day, the organism was identified as P. shigelloides resistant to third- and fourth-generation cephalosporins; ciprofloxacin was given for seven days, and surveillance cultures remained negative. After an uneventful course the patient was discharged on day 10 after LT without signs of infection and is alive with a well-functioning graft. Literature review revealed one case of P. shigelloides in a potential allograft, in which the organism was isolated from heart valves of a drowning victim; the organs were discarded. Reports of freshwater drowning show that bacteremia is universally found post-mortem. Isolated pathogens correspond to specimens from the drowning site, with Aeromonas spp. being the most common and many other microorganisms described anecdotally. Livers from infected donors have been used, in most cases with good results if the recipient and, when possible, donor were treated appropriately; however, cases of fatal pathogen transmission have been reported.
This is the first reported case of a LT using a graft from a donor with P. shigelloides sepsis. Drowning victims should be considered potentially infected with rare pathogens and therefore represent extended-criteria donors.
嗜水气单胞菌是一种与腹泻病相关的淡水、非发酵革兰氏阴性杆菌。人类中罕见的侵袭性感染通常涉及免疫功能低下的个体。
我们报告了 1 例患者，该患者成功接受了肝移植（LT），使用的供体是一名在淡水湖中溺水的 14 岁男孩的器官。在 PubMed 上搜索了报道的有败血症的溺水受害者和使用受感染供体器官进行 LT 的结果。
我们的患者接受了哌拉西林他唑巴坦的预防治疗，在供体血液培养中发现革兰氏阴性菌生长后，于移植后第 1 天将其转换为头孢吡肟。第二天，该病原体被鉴定为对第三代和第四代头孢菌素耐药的嗜水气单胞菌；给予环丙沙星治疗 7 天，监测培养结果均为阴性。患者在 LT 后第 10 天无感染迹象且移植物功能良好出院，此后无并发症。文献复习发现 1 例潜在同种异体供体中的嗜水气单胞菌，该病原体从溺水者的心脏瓣膜中分离出来；这些器官被丢弃。淡水溺水的报道表明，菌血症普遍存在于死后。分离出的病原体与溺水地点的标本相对应，气单胞菌属最为常见，还有许多其他微生物则是偶然描述的。已使用受感染供体的肝脏，如果受者和（如果可能的话）供者得到适当治疗，大多数情况下结果良好；但是，也有致命病原体传播的病例报告。
这是首例报道的使用嗜水气单胞菌败血症供体进行 LT 的病例。溺水者应被视为潜在感染罕见病原体的患者，因此代表了扩展标准供体。
