Monitoring For Infectious Complications Research Articles

Incidence and Risk Factors for Infections After Liver Transplant in Children: Single-Center Experience for 15 Years

BackgroundSurvival after liver transplantation (LT) has improved over the years, but infection is still a major complication and its incidence is higher than other organ transplantations.MethodsWe performed a retrospective analysis of 189 children who received LT between 2000 and 2015 at a single center. Data on incidence, type, and etiology of infections were collected. Risk factors were analyzed through comparison of demographic and clinical variables between patients with and without infectious complicationsResultsA total of 194 infections developed in 114 (60%) patients during the 15 year period (1.03 events per person-year). The most common pathogens were bacteria (n = 132, 68.0%), followed by virus (n = 59, 30.4%) and fungus (n = 3, 1.5%). Among bacterial pathogens, Staphylococcus aureus (15.2%), Enterococcus species (15.2%), and Klebsiella species (13.6%) were most common. Among the viruses, cytomegalovirus (44.0%) and Epstein–Barr virus (32.2%) were most common. Overall, half of the infections occurred within the first month and 87.1% within 6 months after LT. Bacterial infections occurred most frequently within the first month (n = 84, 63.6%), whereas viral infections occurred between one and six months after LT (n = 38, 64.4%). Regarding the organ infected, bloodstream was most common (n = 39, 20.1%), followed by lung (n = 30, 15.4%), peritoneum (n = 28, 14.4%), and urinary tract (n = 25, 12.9%). The overall mortality was 9.0% (n = 17), in which 47.1% (n = 8) of them were attributed to infection; septicemia (n = 4), pneumonia (n = 2), peritonitis (n = 1), and post-transplant lymphoproliferative disorder (n = 1). In multivariate analysis, age at LT <1 year (P = 0.028), cadaveric donor (P = 0.044), pediatric end-stage liver (PELD) score >14 (P = 0.023), operation time >7 hours (P = 0.002), and need of biliary or vascular intervention (P = 0.001) increased the possibility of bacterial infection. However, only long anhepatic time (>60 minutes) was associated with viral infection (P = 0.047).ConclusionProphylactic measures and monitoring for infectious complications are crucial within the first month for bacterial infection and within six months for viral infection after LT, especially in patients with risk factors.Disclosures All authors: No reported disclosures.

Mo1184 Meta-Analysis of Thiopurine Exposure and Risk of Colonic Neoplasia in Inflammatory Bowel Disease

Background: Immunosuppressive medications play an important role in the management of inflammatory bowel disease (IBD). However, elderly patients are excluded from clinical trials and there is a paucity of data regarding the safety of immunosuppressive medications among elderly patients with IBD. The aim of this study was to examine the association between medication exposure and related complications and among elderly patients with IBD. Methods: We performed a cross sectional study of adults patients with IBD who received care at Baylor College of Medicine from July 2009 to June 2013. We identified IBD patients using ICD-9 codes for Crohn's disease (555.xx) and ulcerative colitis (556.xx). Demographic and clinical data were abstracted bymanual chart review using a standardized data abstraction form. Current and past medication exposure were classified as aminosalicylate/sulfasalazine, systemic steroids (prednisone/methylprednisolone), thiopurines (azathioprine, 6-mercaptopurine), methotrexate and biologics (infliximab, adalimumab, and certolizumab pegol). Potential medication-related complications were classified as infection, leukopenia, pancreatitis, hepatitis, osteoporosis/osteopenia, and cancer. The primary endpoint was association of medication exposure with the composite endpoint of any complication. Associations of medications with complications were assessed using univariate and multivariate logistic regression. Results: From a total of 1,525patients with IBD, we identified 144 patients who were 65 years or older at the time of data abstraction; mean age of 71.6 years (SD+6.1); 55% female; 38% with ulcerative colitis, 57% with Crohn's disease, and 5% with IBD unclassified. 32% of patients were observed to have at least one complication. In univariate analyses, thiopurine exposure was associated with an increased odds of any medicationrelated complication (OR 3.23 95% CI 1.53-6.80). On analysis of specific complications, thiopurine exposure was associated with higher rates on infection (OR 2.89 95% CI 1.087.76), but not other complications. None of the other examined medications, including biologics, were associated with medication-related complications. On multivariate analysis adjusting for gender, race, duration of disease and smoking, thiopurine exposure remained statistically significantly associated with the composite endpoint of any complication (OR 4.21 95%CI 1.84-9.65). Conclusions: One third of elderly patients with IBDwere observed to have a complication. Thiopurine exposure was associated with a 3-fold risk of complications compared to all other medication exposures. Biologic exposure was not associated with immediate medication-related complications. Thiopurine use in elderly patients with IBD requires close monitoring for infectious complications.

Dépistage automatisé de l’hémochromatose post-transfusionnelle

Post-transfusion hemochromatosis is a major concern in patients with chronic transfusion (i.e. more than 20 red blood cell concentrates). While the monitoring of infectious complications and transfusion accidents is clearly one of the missions of haemovigilance, hemochromatosis is not yet subject to such a systematic monitoring. We therefore wanted to assess the incidence of this complication in the context of a general hospital (hospital of Aix) and propose the establishment of a screening and a comprehensive monitoring of post transfusion hemochromatosis.

W1099 Adequately Dosed 6-Thioguanine Is a Well Tolerated and Safe Rescue Drug in Azathioprine or 6-Mercaptopurine Intolerant IBD Patients

G A A b st ra ct s end of follow-up. Fourteen experienced any complication, and 5 were infectious complications. These included 2 cases of shingles, and one each of PCP, EBV, and viral meningitis. No covariates predicted clinical success. Significant predictors of 6TGN levels included the dose of allopurinol, age, and BMI. Significant predictors of 6MMP levels included the doses of thiopurine and allopurinol, and BMI. Significant predictors of WBC included dosing, BMI, and age. Despite having only 5 events, there was a trend toward an association between infectious complications and low ALC (OR 7.4, p=0.14, 95% CI 0.51111). Conclusions: Adjunctive allopurinol therapy in shunting patients was successful in producing major clinical improvement in half of patients. However, in this small series, a surprising number of opportunistic infectious complications occurred. BMI has a significant modulating effect on metabolite levels and WBC levels. Low ALC may be an indicator of risk of opportunistic infections. Careful monitoring for infectious complications should be part of thiopurine plus allopurinol therapy for IBD.

Procalcitonin as a marker of nosocomial infections in the neonatal intensive care unit

To determine accuracy of procalcitonin concentrations for diagnosing nosocomial infections in critically ill neonates. Case-control study. Neonatal intensive care unit of a teaching hospital. Twenty-three neonates with nosocomial infection. Four controls matched for duration of hospital stay and birth date were chosen for each case patient. PCT concentrations were measured by the LUMItest procalcitonin kit at onset of signs of infection and after recovery. Range of PCT concentrations (ng/ml) was 2.0 to 249.1 in case patients and 0.08 to 1.0 in controls (sensitivity and specificity, 100%). PCT values returned to normal (<1.0 ng/ml) by day 3 to 7 of appropriate antibiotic therapy. Measurement of PCT concentrations may be useful for early diagnosis and monitoring of infectious complications in neonates during their stay in the neonatal intensive care unit.

Legal implications of xenotransplantation

Abstract: Xenotransplantation (XTx) offers a possible solution to the severe shortage of organs for transplantation, but it will raise new legal questions. There are currently no legal impediments to XTx in the United States nor do animals possess common law or constitutional rights that would prevent it. The law remains indefinite regarding what constitutes a human being, allowing the possibility that legal arguments will be raised regarding the legal status of transgenic animals expressing human tissues or cells. As successful XTx will eliminate the organ shortage, Congress or state legislatures will have to reconsider the need for the current centralized system of allocation and distribution of organs, for this could be replaced by a commercial system based on market forces. The most significant legal issue relating to XTx is probably the potential threat to the public health and safety through the transmission of an infectious disease. The Public Health Service has recently issued draft guidelines which make recommendations about how XTx procedures might be performed. These guidelines currently have no legal authority but offer insight into how XTx might be regulated if it becomes a clinical, reality. Existing federal laws, however, empower federal agencies to regulate XTx, in part because of the potential risk to the public health. Additionally, tort liability will impose legal pressure on transplant centers to minimize the level of risk that the general public might face. The most difficult questions facing legislatures and the Public Health Service may well prove to be those raised by the behavior of individual patients or their social contacts who do not comply with the guidelines/regulations relating to long‐term monitoring for infectious complications.

Infections in Patients with Cellular Immunodeficiency

Despite prophylactic measures, more than half of severely immunocompromised patients acquire infections. The burden of management thus weighs heavily on diagnosis and treatment, both of which have serious limitations. No matter what prophylactic or therapeutic measures have been initiated for a given type of infection, close clinical monitoring for infectious complications is always essential.