Miceli M H, Gonulalan M, Perri M B, Samuel L, Al Fares M A, Brown K, Bruno D A, Zervos M, Ramesh M, Alangaden G
Department of Internal Medicine, Division of Infectious Diseases, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
Transpl Infect Dis. 2015 Feb;17(1):140-6. doi: 10.1111/tid.12330. Epub 2015 Jan 14.
Donors not meeting standard criteria, such as those with bacteremia, are now being used in response to the increasing need for organs for transplantation. Recommended strategies to prevent the occurrence of donor-derived bacteremia include the use of directed antibiotic prophylaxis. However, this approach does not eliminate the risk of infection transmission. Similarly, the management of organ recipients from donors with infective endocarditis (IE) remains uncharacterized. We report 2 cases of donor-derived bacterial infections in liver transplant recipients despite pathogen-specific antibiotic prophylaxis. In both instances, the donors had documented IE treated with appropriate antimicrobial therapy and clearance of bacteremia. Recipients had very distinctive clinical outcomes likely related to pathogen virulence and the extent of donor infection. Persistent infection in the transplanted liver should be suspected in organ recipients of a liver from donors with IE, despite the absence of bacteremia at the time of death and organ procurement. For eradication, recipients may require prolonged pathogen-directed antimicrobial therapy, such as is used for endovascular infections. Prompt recognition of donors with IE, appropriate notification, and prolonged antibiotic prophylaxis are key to reducing the risk of such donor-derived infections.
不符合标准标准的供体，如患有菌血症的供体，目前正被用于应对移植器官需求的不断增加。推荐的预防供体源性菌血症发生的策略包括使用针对性抗生素预防。然而，这种方法并不能消除感染传播的风险。同样，来自患有感染性心内膜炎（IE）供体的器官接受者的管理仍未明确。我们报告了2例肝移植受者发生供体源性细菌感染的病例，尽管采取了针对病原体的抗生素预防措施。在这两例中，供体均有记录的IE，接受了适当的抗菌治疗且菌血症已清除。受者有非常独特的临床结果，可能与病原体毒力和供体感染程度有关。对于来自患有IE供体肝脏的器官接受者，即使在死亡和器官获取时没有菌血症，也应怀疑移植肝脏存在持续感染。为了根除感染，受者可能需要延长针对病原体的抗菌治疗，如用于血管内感染的治疗。及时识别患有IE的供体、适当通知并延长抗生素预防是降低此类供体源性感染风险的关键。
