L. Adadynski

Urinary tract infections in the early posttransplant period after liver transplantation: etiologic agents and their susceptibility.

BACKGROUND We performed an analysis of etiologic agents for urinary tract infections in the early posttransplant period after orthotopic liver transplantation (OLT) in adult recipients. PATIENTS AND METHODS The study covered the first 4 weeks after OLT of 190 patients from September 2001 to the end of 2007. Immunosuppression consisted of steroids and tacrolimus. Antimicrobial prophylaxis was piperacillin/tazobactam, fluconazole, and SBD. Urine samples were cultured to identify microorganisms in accord with standard microbiological procedures and to test susceptibility using Clinical Laboratory and Standards Institute guidelines. RESULTS Urine specimens (n=539) examined from 185 recipients (97.4%) showed 210 microbial strains. The most common were Gram-negative (n=131; 62.4%) with predominance of Escherichia coli (28.2%), Enterobacter cloacae (19.1%), and Acinetobacter baumannii (11.4%). Extended-spectrum β- lactamases (ESBL(+)) strains were isolated in 38.5% of cases. Gram-positive bacteria comprised 28.6% (n=60): The most common strains were enterococci (85% including HLAR 80.4% and VRE 17.6%] and staphylococci 11.8% [MRSA/MRCNS; 100%]. There were 19 (9%) fungal strains. CONCLUSIONS In general, the identification in urine samples of multi-drug-resistant bacterial and fungal strains in patients after OLT such as ESBL(+) 38.5%; HLAR 80.4%; VRE 17.6%; and MRSA/MRCNS 100% requires better infection control.

Molecular epidemiology of vancomycin-resistant Enterococcus faecium infecting recipients of solid organs in the transplant surgery ward in 2005 and 2006.

BACKGROUND The aim of the investigations was to compare the vancomycin-resistant Enterococcus faecium (VREfm) strains obtained from our patients. MATERIALS AND METHODS Strains were compared using restriction fragment length polymorphism-pulsed field gel electrophoresis (RFLP-PFGE) of bacterial DNA. RESULTS VREfm infected 26 liver recipients, 22 kidney recipients, and 9 other surgery or nephrology patients. Only five strains possessed the vanB determinant. The PFGE analysis revealed two large and several small groups of related strains. CONCLUSIONS The PFGE analysis enabled the investigation of VRE epidemiology among patients after transplantation. Strains with similar patterns most probably originated from one source and clearly suggested an outbreak.

Molecular epidemiology of vancomycin-resistant Enterococcus faecalis among patients of transplantology wards.

OBJECTIVE Vancomycin-resistant enterococci (VRE) require epidemiological monitoring especially in transplantation wards. The aim of our work was to perform a molecular analysis of vancomycin-resistant Enterococcus faecalis (VREfl) strains among solid organ recipients during various years. MATERIALS AND METHODS Strains were examined for the presence of different genes determining vancomycin resistance: vanA, vanB, vanD, or vanG by polymerase chain reaction (PCR). Restriction fragment length polymorphism (RFLP)-pulsed field gel electrophoresis (PFGE) was performed on bacterial DNA digested with SmaI enzyme. RESULTS From 2003 to 2006, we isolated 12 strains of VREfl from 8 patients (2 liver and 6 kidney transplantations). All strains harbored the vanA gene. Among the strains, 5 displayed patterns similar to each other, despite being isolated from different patients, and were susceptible to ampicillin with high resistance to aminoglycosides. CONCLUSIONS These results suggested that a single strain of VREfl was present for 3 years in closely related hospital wards, but it disappeared in the following years.