Prevalence of vancomycin-resistant Enterococcus fecal colonization among kidney transplant patients

BACKGROUND: End stage renal disease patients are at risk of Vancomycin-Resistant Enterococcus (VRE) infections. The first reports of VRE isolation were from hemodialysis patients. However, to date, VRE fecal colonization rates as well as associated risk factors in kidney transplant patients have not yet been established in prospective studies. METHODS: We collected one or two stool samples from 280 kidney transplant patients and analysed the prevalence of VRE and its associated risk factors. Patients were evaluated according to the post-transplant period: group 1, less than 30 days after transplantation (102 patients), group 2, one to 6 months after transplantation (73 patients) and group 3, more than 6 months after transplantation (105 patients). RESULTS: The overall prevalence rate of fecal VRE colonization was 13.6% (38/280), respectively 13.7% for Group 1, 15.1% for group 2 and 12.4% for group 3. E. faecium and E. faecalis comprised 50% of all VRE isolates. No immunologic variables were clearly correlated with VRE colonization and no infections related to VRE colonization were reported. CONCLUSION: Fecal VRE colonization rates in kidney transplant patients were as high as those reported for other high-risk groups, such as critical care and hemodialysis patients. This high rate of VRE colonization observed in kidney transplant recipients may have clinical relevance in infectious complications

Kinetics of progenitor hemopoetic stem cells in sepsis: Correlation with patients survival?

BACKGROUND: Current theories underline the crucial role of pro-inflammatory mediators produced by monocytes for the pathogenesis of sepsis. Since monocytes derive from progenitor hemopoetic cells, the kinetics of stem cells was studied in peripheral blood of patients with sepsis. METHODS: Blood was sampled from 44 patients with septic syndrome due to ventilator-associated pneumonia on days 1, 3, 5 and 7 upon initiation of symptoms. Concentrations of tumour necrosis factor-alpha (TNFα), interleukin (IL)-6, IL-8 and G-CSF were estimated by ELISA. CD34/CD45 cells were determined after incubation with anti-CD45 FITC and anti-CD34 PE monocloncal antibodies and flow cytometric analysis. Samples from eight healthy volunteers served as controls. RESULTS: Median of CD34/CD45 absolute count of controls was 1.0/μl. Respective values of the total study population were 123.4, 112.4, 121.5 and 120.9/μl on days 1, 3, 5 and 7 (p < 0.0001 compared to controls). Positive correlations were found between the absolute CD34/CD45 count and the absolute monocyte count on days 1, 5 and 7. Survival was prolonged among patients with less than 310/μl CD34/CD45 cells on day 1 compared to those with more than 310/μl of CD34/CD45 cells (p: 0.022). Hazard ratio for death due to sepsis was 5.47 (p: 0.039) for CD34/CD45 cells more than 310/μl. Median IL-6 on day 1 was 56.78 and 233.85 pg/ml respectively for patients with less than 310/μl and more than 310/μl CD34/CD45 cells (p: 0.021). CONCLUSION: Stem cells are increased in peripheral blood over all days of follow-up compared to healthy volunteers. Patients with counts on day 1 less than 310/μl are accompanied by increased survival compared to patients with more than 310/μl

Decreased Cytomegalovirus infection after antilymphocyte therapy in sirolimus-treated renal transplant patients

Cytomegalovirus (CMV) infection is highly prevalent in transplant patients, especially in those submitted to a more intense immunosuppression. We monitored CMV infection in 34 patients during 60 days after antilymphocyte therapy without CMV prophylaxis. Six patients received sirolimus and 28 received no sirolimus as immunosuppression. During 60 days, of follow-up time, 24/28 (86%) patients who did not use sirolimus developed CMV infection at a mean time of 32.43 +/- 13.61 days after antilymphocyte treatment. in contrast, no patient on sirolimus had CMV infection during the same follow-up (p<0.001). During a further 4-month follow-up, six patients on sirolimus-free therapy had recurrence of CMV 46.5 +/- 18.5 days after them first episode. During this same period, one patient receiving sirolimus had one positive cell for CMV antigenemia, 169 days, after antilymphocyte therapy. in conclusion, the use of sirolimus significantly reduced the incidence of CMV infection in patients treated with antilymphocyte antibodies. (C) 2004 Elsevier B.V. All rights reserved.Universidade Federal de São Paulo, Div Nephrol, BR-04023900 São Paulo, BrazilUniversidade Federal de São Paulo, Div Infect Dis, Escola Paulista Med, Hosp Rim & Hipertensao, São Paulo, BrazilUniversidade Federal de São Paulo, Div Nephrol, BR-04023900 São Paulo, BrazilUniversidade Federal de São Paulo, Div Infect Dis, Escola Paulista Med, Hosp Rim & Hipertensao, São Paulo, BrazilWeb of Scienc

Comparison between antigenemia and a quantitative-competitive polymerase chain reaction for the diagnosis of cytomegalovirus infection after heart transplantation

Background Antigenemia and quantitative polymerase chain reaction (PCR) are widely used for cytomegalovirus (CMV) diagnosis after heart transplantation due to their enhanced, predictive values for disease detection when specific cut-off Values are used. the purpose of this study was to compare, in the same patient setting, the predictive values of quantitative PCR and antigenemia for GMV disease detection, using specific cut-off values.Methods. Thirty heart transplant receptors were prospectively monitored for active CMV infection and disease detection, using quantitative PCR and anti-genemia, Positive and negative predictive values for CMV disease detection were calculated using cut-off values for both antigenemia (5 and 10 positive cells/ 300,000 neutrophils) and quantitative-PCR (50,000 and 100,000 copies/10(6) leukocytes).Results, Active CMV infection was diagnosed in 93.3% of patients and CMV disease in 23.3%, the positive and negative predictive (%) values for CMV disease detection were 35/100 and 46.7/100, respectively, for quantitative PCR and antigenemia. Using 5 and 10 positive cells/300,000 neutrophils as cut-off values for antigenemia, the positive and negative predictive values (%) for disease detection were respectively 63.6/100 and 70/100, for quantitative PCR, the positive and negative predictive values (%) for cut-off values of 50,000 and 100,000 copies/10(6) leukocytes were 53.8/100 and 60/94.1, respectively.Conclusion. in our series, antigenemia and quantitative-PCR had enhanced and similar predictive values for CMV disease detection when specific cut-off values were used. the choice between these two methods for disease detection may rely less on their efficiency and more on the experience and familiarity with them.Univ São Paulo, Sch Med, Inst Heart, São Paulo, BrazilUniv São Paulo, Sch Med, Virol Lab, Inst Met Trop São Paulo,Infect Dis Dept, São Paulo, BrazilLudwig Inst Canc Res, São Paulo, BrazilWeb of Scienc