1520. Transmission of bacterial infection from solid organ transplant donors with infective endocarditis despite pre-mortem clearance of bacteremia
Session: Poster Abstract Session: Infections and Transplantation
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • DD-ID Poster_3 5x7_2013.pdf (125.2 kB)
  • Background:

    Marginal organ donors, such as those with bloodstream infection (BSI), are now utilized in response to the increasing need of organs for transplantation. Strategies to prevent the occurrence of donor-derived BSI include the use of directed antibiotic prophylaxis (AP). 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 on donor-derived bacterial infections occurring despite specific AP in liver transplant recipients (LTR) from donors with IE and confirmed clearance of BSI at the time of death.

    Methods:

    2 cases of donor-derived bacterial infections were identified. Recipients medical records were reviewed. Pertinent information regarding donors was obtained through United Network for Organ Sharing. Cases were defined as LTRs who after transplantation developed infection with the same bacteria with identical antibiotic susceptibility and pulsed-field gel electrophoresis (PFGE) patterns as the bacteria isolated from blood cultures from the donors.

    Results:

    a) A 59 year-old LTR developed severe sepsis and perihepatic abscess with vancomycin-susceptible Enterococcus faecalis(VSE) on day 9 after transplant despite appropriate AP. Donor had VSE IE with documented clearance of BSI pre-mortem. Susceptibility tests and PFGE of VSE isolates from donor and recipient were identical. 

    b) A 41 year-old LTR developed methicillin-resistant Staphylococcus aureus(MRSA) BSI 24 h after transplant treated with 2 weeks of daptomycin. 74-days later, he developed MRSA-BSI and septic emboli. Donor died from MRSA IE with documented clearance of BSI. MRSA isolated from donor and LTR were identical by PFGE.  

    Conclusion:

    Donor-derived bacterial infection from donors with IE occurred despite documented clearance of BSI and use of appropriate AP. Persistent infection in transplanted organs should be suspected in LTRs who receive organs from donors with IE despite absence of BSI at time of death. For eradication, recipients may require prolonged pathogen-directed antimicrobial therapy such as used for endovascular infections. Prompt recognition of donors with IE and appropriate notification are key to reduce the burden of such donor-derived infections.

    Marisa Miceli, MD1, Murat Gonulalan, MD1, Mary Perri, MT1, Linoj Samuel, PhD2, Kimberly Brown, MD3, David Bruno, MD4, Ioannis Theodoropoulos, MD4, Marcus Zervos, MD1, Mayur Ramesh, MD1 and George Alangaden, MD1, (1)Infectious Diseases, Henry Ford Hospital, Detroit, MI, (2)Microbiology and Pathology, Henry Ford Hospital, Detroit, MI, (3)Hepatology, Henry Ford Hospital, Detroit, MI, (4)Transplant Institute, Henry Ford Hospital, Detroit, MI

    Disclosures:

    M. Miceli, None

    M. Gonulalan, None

    M. Perri, None

    L. Samuel, None

    K. Brown, None

    D. Bruno, None

    I. Theodoropoulos, None

    M. Zervos, None

    M. Ramesh, None

    G. Alangaden, None

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