626. Transmission of Methicillin-Resistant Staphylococcus aureus Infection Through Solid Organ Transplantation
Session: Oral Abstract Session: Infections in Transplantations and Immunocompromised
Friday, October 4, 2013: 8:30 AM
Room: The Moscone Center: 220-226
Background: Donor-derived infection transmission is suspected in 1-2% of solid organ transplants, and can result in allograft failure or recipient death. Use of organs from donors with risk factors associated with HIV, hepatitis B and/or C infection requires recipient informed consent. However, these guidelines are not intended to be applied for risk-stratification related to bacterial infections. In January 2013, CDC was notified of an organ recipient who developed methicillin-resistant Staphylococcus aureus(MRSA) bacteremia 6 days after receiving lungs from a donor with endocarditis and MRSA bacteremia. We investigated to determine whether this was donor-derived, and the extent of transmission.

Methods: Donor and recipients’ medical records were reviewed, including antibiotic susceptibility test (AST) results. Cases were defined as recipients from the common donor who, following transplantation, developed MRSA infection matching donor’s AST results. Donor’s post-mortem formalin-fixed paraffin-embedded mitral valve (MV) tissue was subjected to S. aureus DNA extraction and polymerase chain reaction. The S. aureus DNA from donor and lung recipient samples were tested for spa type and mecA and Panton-Valentine leukocidin (PVL) genes. Blood culture isolates from lung and liver recipients were compared by pulsed-field gel electrophoresis (PFGE).

Results: Four recipients received 5 solid organs. All recipients started MRSA prophylaxis at the time of transplant. Lung and liver recipients became cases; none died. Donor and lung recipient S. aureus were spa type t008, and positive for mecA IVa and PVL, consistent with MRSA USA300 strain. The liver recipient developed MRSA bacteremia 3 hours post-transplantation and despite therapy, was re-admitted from a long-term rehabilitation facility 58 days post-discharge with MRSA bacteremia; the USA300-0114 strain matched the lung recipient’s isolates by PFGE.

Conclusion: Two cases of donor-derived MRSA bacteremia occurred despite prophylaxis. Infection with virulent multi-drug resistant organisms (MDRO) may pose treatment challenges among immunosuppressed organ recipients. Recipient informed consent should be expanded to include risk assessment for potential adverse outcomes when using organs from donors with endocarditis caused by virulent MDRO.

Joyanna Wendt, MD, MPH, Division of Healthcare Quality Promotion, CDC, Atlanta, GA, Hana Akselrod, MPH, Mount Sinai Medical School, new york, NY, Stephen Cohle, MD, Kent County Office of Medical Examiner, Grand Rapids, MI, Daniel Kaul, MD, University of Michigan Medical School, Ann Arbor, MI, Mayur Ramesh, MD, Infectious Diseases, Henry Ford Hospital, Detroit, MI, Amy Denison, PhD, CDC / Infectious Diseases Pathology Laboratory, Atlanta, GA, Albania, Marlene Deleon-Carnes, BA, CDC/ Infectious Diseases Pathology Laboratory, Atlanta, GA, Dianna M. Blau, DVM, PhD, Infectious Disease Pathology Laboratory, Centers for Disease Control and Prevention, Atlanta, GA, Christopher Paddock, MD, MPHTM, CDC, Atlanta, GA, Matthew J. Kuehnert, MD, FIDSA, Centers for Disease Control and Prevention, Atlanta, GA and Sridhar Basavaraju, MD, FACEP, CDC/ Division of Healthcare Quality Promotion, atlanta, GA

Disclosures:

J. Wendt, None

H. Akselrod, None

S. Cohle, None

D. Kaul, None

M. Ramesh, None

A. Denison, None

M. Deleon-Carnes, None

D. M. Blau, None

C. Paddock, None

M. J. Kuehnert, None

S. Basavaraju, None

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