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G B Ko,
T Kim,
S-H Kim,
S-H Choi,
Y S Kim,
J H Woo,
Y H Kim,
J B Park,
S K Lee,
S-K Park,
J S Park,
D J Han, S-O Lee
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ABSTRACT: BACKGROUND: Herpes zoster (HZ) is a common infectious disease after kidney transplantation (KT). The incidence of HZ may increase during cytomegalovirus (CMV) preemptive therapy. We therefore evaluated the incidence, risk factors, and clinical outcomes of HZ after KT, according to the type of CMV prophylaxis used. METHODS: We retrospectively established a cohort of KT recipients who underwent transplantation from June 2008 to May 2010. Patients were categorized into 3 groups according to CMV prophylaxis regimen: Group A (preemptive therapy), Group B (universal prophylaxis <3 months), and Group C (universal prophylaxis >3 months). The incidence rate of HZ was compared in each group, and risk factors for HZ were identified. RESULTS: The incidence rate of HZ was 46.6 (95% confidence interval [CI] 31.4-66.5) per 1000 person-years. The incidence rate was higher in Group A than in Group C (80.0 vs. 13.0 per 1000 person-years; P = 0.001). Median onset time of HZ after KT was shorter in Group A than in Group B (0.9 vs. 9.9 months; P < 0.001) and Group C (0.9 vs. 14.8 months; P = 0.008). Post-herpetic neuralgia occurred in 7 patients (23%). No visceral involvement or death was related to HZ. By multivariate analysis, only female gender (corrected relative risk 1.59; 95% CI 1.09-2.00) was independently associated with HZ development. CONCLUSIONS: In the setting of CMV preemptive therapy, a differentiated varicella zoster virus-specific prophylaxis might be necessary for patients with HZ risk factors.
Transplant Infectious Disease 05/2013; · 2.22 Impact Factor
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ABSTRACT: BACKGROUND: Toll-like receptor 3 (TLR3) is implicated in the pathogenesis of viral diseases owing to its ability to recognize viral double-stranded RNA. We hypothesized that single nucleotide polymorphism (SNP) in TLR3 gene that impairs the function of the protein-receptor influences the outcome of hepatitis C virus (HCV) infection after liver transplantation. METHODS: The clinical characteristics of 611 liver recipients (HCV-infected: n = 153, non-HCV-infected: n = 458) were assessed to investigate the impact of TLR3 L412F SNP on transplant outcomes. RESULTS: TLR3 L412F is common, and it was significantly more prevalent among the HCV-infected cohort (57.5% vs. 45.2%, P = 0.008). In a multivariate analysis, TLR3 L412F was significantly associated with chronic hepatitis C (odds ratio: 1.73, 95% confidence interval [CI]: 1.13-2.65, P = 0.01). In an analysis that compared HCV-infected patients with wild-type versus TLR3 L412F, a marginally higher rate of allograft failure and mortality was observed in the TLR3 L412F group (44.3% vs. 30.8%, P = 0.09). However, in a multivariate analysis, only donor age was significantly associated with allograft failure and mortality (relative risk: 1.04, 95% CI: 1.007-1.06, P = 0.02). CONCLUSION: TLR3 L412F is significantly common in HCV-infected liver recipients, and may be associated with worse outcomes. However, larger studies are needed to determine its significant association with allograft failure and mortality after liver transplantation for chronic hepatitis C.
Transplant Infectious Disease 12/2012; · 2.22 Impact Factor
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S-Y Park,
Y P Chong,
H J Park,
K-H Park,
S M Moon,
J-Y Jeong,
M-N Kim,
S-H Kim, S-O Lee,
S-H Choi,
J H Woo,
Y S Kim
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ABSTRACT: PURPOSE: Persistent Staphylococcus aureus bacteremia (SAB) has been observed in patients with eradicated foci, but there are few studies of the risk factors and clinical outcomes of persistent bacteremia. This study determined the risk factors for persistent methicillin-resistant S. aureus (MRSA) bacteremia in patients without retained eradicable foci, including genotypic characteristics. METHODS: All adult SAB patients were investigated between 2008 and 2010. Persistent bacteremia was defined as bacteremia lasting >7 days after treatment and patients were monitored prospectively. The study included patients without retained eradicable foci, e.g., removed prosthetic devices and intravenous catheters removed after diagnosis, and those without metastatic infections. RESULTS: Persistent bacteremia occurred in 36 % (31/87) SAB patients with eradicated foci. There were no significant differences in successful defervescence (2.0 vs. 2.0 days, P = 0.55) and total length of hospital stay after bacteremia in the persistent bacteremia group and resolved bacteremia group (P = 0.32). The difference in MRSA bacteremia-related 30-day mortality with persistent bacteremia and resolved bacteremia was not significant (P = 0.12). However, agr dysfunction was higher in persistent bacteremia patients (94 %) than those with resolved bacteremia (75 %, P = 0.03). Multivariate analysis using a logistic regression model found that only agr dysfunction [odds ratio (OR) 4.83, 95 % confidence interval (CI) 1.02-22.89, P = 0.04] was an independent risk factor for persistent bacteremia. CONCLUSIONS: This study suggests that persistent bacteremia with eradicated foci might not adversely affect the outcome for MRSA bacteremia patients. agr dysfunction in S. aureus was significantly associated with persistent bacteremia.
Infection 10/2012; · 2.66 Impact Factor
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H J Park,
Y-M Lee,
K M Bang,
S-Y Park,
S M Moon,
K-H Park,
Y P Chong,
S-H Kim, S-O Lee,
S-H Choi,
J-Y Jeong,
J H Woo,
Y S Kim
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ABSTRACT: Patients with liver cirrhosis (LC) have impaired immunity and thus are predisposed to infections. Few studies have attempted to evaluate Staphylococcus aureus bacteremia (SAB) in LC patients. Therefore, this study prospectively evaluated the clinical characteristics and outcomes of 642 episodes of SAB from August 1, 2008 to September 31, 2010. Of 642 patients with SAB, 109 (17.0 %) were classified as LC patients whereas the remaining 533 (83.0 %) were classified as non-LC patients. The 30-day mortality rate of LC patients was significantly higher than that of patients with other diseases (32 % vs. 22 %, respectively; P = 0.047). The 30-day mortality rates of patients with MSSA bacteremia and MRSA bacteremia were not significantly different among LC patients (35.1 % with MSSA vs. 26.9 % with MRSA; P = 0.41). A univariate analysis of the 30-day mortality rate of LC patients with SAB for survivors and non-survivors showed that rapidly fatal or ultimately fatal according to the criteria of McCabe and Jackson (OR 5.0; 95 % CI 1.60-15.65), septic shock at initial presentation (OR 3.5; 95 % CI 1.18-10.39) and Child-Pugh class C (OR 2.8; 95 % CI 1.20-6.59) were associated with increased mortality. In contrast, the removal of the eradicable focus was associated with decreased mortality (OR 0.14; 95 % CI 0.04-0.52). Disease severity and liver dysfunction may be useful for predicting the prognosis of SAB in LC patients.
European Journal of Clinical Microbiology 07/2012; · 2.86 Impact Factor
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S M Moon, S-O Lee,
S-H Choi,
Y S Kim,
J H Woo,
D H Yoon,
C Suh,
D-Y Kim,
J-H Lee,
Je-H Lee,
K-H Lee,
S-H Kim
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ABSTRACT: A total of 244 patients including 100 (41%) autologous hematopoietic stem cell transplant (HCT) recipients and 144 (59%) allogeneic HCT recipients were enrolled over a 28-month period. During the study period, no prophylaxis for latent tuberculosis (TB) infection was administrated. Of these, 201 (82%) had Bacillus Calmette-Guérin (BCG) scars or prior histories of BCG vaccination. The tuberculin skin test (TST) and the QuantiFERON-TB Gold In-Tube (QFT-GIT) test were performed simultaneously in all 244 patients. TST indurations were ≥ 5 mm in 39 of these patients (15%), and in 25 (10%) indurations were ≥ 10 mm. In addition, 40 (16%) had positive QFT-GIT outcomes, and 34 (14%) indeterminate outcomes. If the 34 patients with indeterminate QFT-GIT results were excluded from the overall agreement analysis, the agreement between the TST results (induration size ≥ 5 mm) and the QFT-GIT results in the 210 patients with clear QFT results was poor (κ = 0.08, 95% confidence interval [CI] -0.06 to 0.24), as it was for the patients with indurations ≥ 10 mm (κ = 0.15, 95% CI -0.004 to 0.31). During follow up, 2 patients developed TB after HCT. The incidence of TB in the patients with positive QFT-GIT outcomes was 2.80 per 100 person-years (95% CI 0.07-15.81), whereas among those with positive TST (≥ 5 mm) results, it was 0 per 100 person-years (95% CI 0-8.00). However, this finding should be cautiously interpreted because of the relatively short follow up and the fact that the sample size of the study cohort did not have adequate power. In conclusion, our data show that, although the frequencies of positive outcomes in the 2 TB screening tests were similar, the overall agreement between the TST and the QFT-GIT test was poor, regardless of BCG vaccination history.
Transplant Infectious Disease 07/2012; · 2.22 Impact Factor
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C Lim,
J B Seo,
S-Y Park,
H-J Hwang,
H J Lee, S-O Lee,
E J Chae,
K-H Do,
J-W Song,
M Y Kim,
S-H Kim
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ABSTRACT: AIM: To assess initial and follow-up CT findings of invasive pulmonary aspergillosis (IPA) in solid organ transplant (SOT) recipients using new diagnostic criteria, and to compare initial CT findings of survivors with those of patients who died. MATERIALS AND METHODS: Forty-six adult SOT patients who met the 2008 EORTC/MSG criteria for proven or probable invasive pulmonary aspergillosis were assessed. Initial CT findings of the 21 survivors and 15 patients who died of IPA-related causes were compared using the internationally recognized thoracic glossary of terms. The extents of the largest lesions in each of 18 surviving were measured and changes of those lesions were recorded. RESULTS: Consolidation or mass was the most common finding, observed in 33 of 46 patients (72%), followed by large nodules (59%), ground-glass opacity (50%), and infarcted consolidation (48%). Consolidation or mass was significantly less frequent in survivors than in patients who died (62% versus 93%). Cavitation was more common (43% versus 13%), and significantly smaller (7.5cm(2) versus 19cm(2), p=0.014) in survivors. Follow-up CT in survivors showed that the halo sign resolved rapidly within 4 weeks. The extent of consolidation, infarcted consolidation, and internal low-density area decreased gradually with time to reduce to half the size in 3 weeks. Large nodules persisted for the first 7 days (84%), followed by slow regression. CONCLUSION: Consolidation or mass is the most common CT finding of IPA in SOT recipients. Absence of consolidation or mass and presence of small cavities may be associated with better prognosis. The time for resolution of each pattern after treatment varies.
Clinical radiology 07/2012; · 1.65 Impact Factor
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S-H Choi,
J-W Chung,
B-N Kim,
Y G Kwak,
T H Kim,
E J Lee,
E J Choo,
M-H Jeon,
M S Lee,
I-G Bae,
S-R Lee,
E H Song,
J-B Jun,
M-N Kim,
S-H Kim, S-O Lee,
Y S Kim,
J H Woo
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ABSTRACT: The clinical implication of extended-spectrum cephalosporin (ESC) resistance has been unclear in patients with Streptococcus pneumoniae meningitis (SPM). We collected the clinical data of 120 patients with SPM in 12 hospitals of the Republic of Korea. The clinical characteristics and outcomes of 23 ESC-nonsusceptible SPM episodes were compared to those of 97 ESC-susceptible episodes. Hospital acquisition, presence of other foci of pneumococcal infection, septic shock at initial presentation, or concomitant bacteremia were more commonly observed in ESC-nonsusceptible than ESC-susceptible SPM. Empiric antimicrobial therapy with vancomycin and ESC combination was very common in both groups. Although there was a tendency towards higher early fatality in ESC-nonsusceptible SPM (3-day mortality; 17.4 % vs. 4.4 %, p = 0.05), in-hospital mortality (26.1 % vs. 20.9 %, p = 0.59) and median length of hospital stay (20 days vs. 24 days, p = 0.34) did not differ between ESC-nonsusceptible and ESC-susceptible SPM.
European Journal of Clinical Microbiology 06/2012; 31(11):3029-34. · 2.86 Impact Factor
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European Respiratory Journal 03/2012; 39(3):768-70. · 5.89 Impact Factor
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ABSTRACT: Human herpesvirus-6 (HHV-6) is unique among human herpesviruses because of its ability to integrate into chromosomes. This entity, termed chromosomally integrated HHV-6 (CIHHV-6), is often mistaken for active infection and treated unnecessarily. The clinical significance of CIHHV-6 in transplant recipients is not defined. Herein, the clinical characteristics of 7 liver transplant patients with CIHHV-6 from our recent study, together with 14 other published cases of CIHHV-6 were reviewed. Of the 21 cases, CIHHV-6B was reported most commonly among solid organ transplant recipients, while CIHHV-6A was mostly seen in allogeneic hematopoietic stem cell recipients. None of the 21 patients developed clinical symptoms related to HHV-6 after transplantation. However, antiviral therapy was administered to 5 asymptomatic patients mistaken to have HHV-6 infection because of their very high HHV-6 DNA levels, 3 who developed symptomatic cytomegalovirus disease, and 1 with graft-versus-host disease that was mistaken for HHV-6 infection. In patients who received antiviral therapy, there was no apparent decline in HHV-6 DNA load, although change in viral kinetics is difficult to discern in the setting of high baseline HHV-6 DNA load. Clinicians should be aware of this entity of CIHHV-6 so that antiviral therapy can be considered in the proper clinical context.
Transplant Infectious Disease 02/2012; 14(4):346-54. · 2.22 Impact Factor
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ABSTRACT: Data are limited on the value of non-invasive diagnostic methods, such as the cytomegalovirus (CMV) antigenemia assay, and the clinical features of CMV pneumonia in patients who have undergone solid organ transplant (SOT) compared with those who have had hematopoietic stem cell transplant (HSCT). All adult patients with suspected CMV pneumonia, who had received SOT or HSCT in a tertiary hospital during a 5-year period, were retrospectively enrolled. CMV pneumonia was defined as clinical and radiographic evidence of pneumonia in association with the isolation of CMV in viral cultures of bronchoalveolar lavage or lung tissue specimens, or with the identification of CMV in lung tissue. In total, 36 patients with CMV pneumonia were identified. Of these, 29 (80%) had received SOT and 7 (20%) had received HSCT. The incidence of CMV pneumonia in the patients with SOT (3.0 per 1000 person-years [95% confidence interval {CI} 0.6-8.7]) was lower than in those with HSCT (17.0 per 1000 person-years [95% CI 9.9-27.2], P = 0.003) and CMV-related mortality showed a tendency to have lower mortality in patients with SOT (10% [3/29]) than with HSCT (43% [3/7], P = 0.07). The overall sensitivity of the CMV assay (≥ 1/200,000 leukocytes) in patients with CMV pneumonia was 69% (95% CI 52-84%). The CMV antigenemia test is of limited value in diagnosing CMV pneumonia, given the high cost of false-negative diagnoses of CMV pneumonia.
Transplant Infectious Disease 01/2012; 14(2):192-7. · 2.22 Impact Factor
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S-H Kim, S-O Lee,
J B Park,
I-A Park,
S J Park,
S-C Yun,
J H Jung,
Y H Kim,
S C Kim,
S-H Choi,
J-Y Jeong,
Y S Kim,
J H Woo,
S-K Park,
J S Park,
D J Han
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ABSTRACT: We evaluated whether ELISPOT assay can predict tuberculosis (TB) development in kidney-transplantation (KT) recipients with a negative tuberculin skin test (TST). All adult patients admitted to a KT institute between June 2008 and December 2009 were enrolled; TB development after KT was observed between June 2008 and December 2010. Isoniazid (INH) was given to those patients with positive TST or clinical risk factors for latent TB infection (LTBI). ELISPOT assay was performed on all patients, and TB development after KT was observed by a researcher blinded to the results of ELISPOT. A total of 312 KT recipients including 242 (78%) living-donor KT were enrolled. Of the 312 patients, 40 (13%) had positive TST or clinical risk factors for LTBI and received INH; none developed TB after KT. Of the remaining 272 patients, 4 (6%) of 71 with positive ELISPOT assay developed TB after KT, whereas none of the 201 patients with negative (n = 171) or indeterminate ELISPOTs (n = 30) developed TB after KT (rate difference between positive and negative/indeterminate ELISPOT, 3.3 per 100 person-years [95% CI 1.4-5.1, p<0.001]). Positive ELISPOT results predict subsequent development of TB in KT recipients in whom LTBI cannot be detected by TST or who lack clinical risk factors for LTBI.
American Journal of Transplantation 07/2011; 11(9):1927-35. · 6.39 Impact Factor
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S Na,
H J Park,
K-H Park,
O-H Cho,
Y P Chong,
S-H Kim, S-O Lee,
H Sung,
M-N Kim,
J-Y Jeong,
Y S Kim,
J H Woo,
S-H Choi
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ABSTRACT: Because Enterococcus avium is rarely isolated from blood cultures, little is known about the clinical features and outcomes of bacteremia caused by this organism, formerly called "group Q streptococcus". We retrospectively evaluated the clinical features and outcomes of patients with clinically significant bacteremia caused by E. avium presenting at a tertiary-care hospital in Korea between February 1997 and February 2009. We identified 53 patients over the 12-year period; of these, 27 (50.9%) had biliary and 13 (24.5%) had intra-abdominal E. avium infections. Thirty-six (67.9%) of the episodes were polymicrobial. Thirty-three (62.3%) episodes were nosocomial bloodstream infections and resistance to vancomycin was not observed. The crude mortality rate was 24.5% (13/53), and the E. avium bacteremia-related mortality rate was 11.3% (6/53). Multivariate analysis showed that underlying rapidly fatal or ultimately fatal disease (adjusted odds ratio [AOR], 6.92; 95% confidence interval [CI], 1.56-30.65; P = 0.011) and inadequate antimicrobial therapy (AOR, 7.29; CI, 1.27-41.93; P = 0.026) were independent risk factors for mortality. In summary, bacteremia due to E. avium was commonly of biliary or intraabdominal origin and was often associated with polymicrobial bacteremia. The crude mortality rate was considerable. Severe underlying conditions and inadequate antimicrobial therapy were significant and independent risk factors for crude patient mortality.
European Journal of Clinical Microbiology 06/2011; 31(3):303-10. · 2.86 Impact Factor
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S-H Kim, S-O Lee,
I-A Park,
S J Park,
S-H Choi,
Y S Kim,
J H Woo,
S-K Park,
J S Park,
S C Kim,
D J Han
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ABSTRACT: The presence of latent tuberculosis (TB) infection (LTBI) should be evaluated before kidney transplantation. Although a new T cell-based assay for diagnosing LTBI gave promising results, this assay has not yet been compared with the tuberculin skin test (TST) for diagnosing LTBI in renal transplant candidates before transplantation.
All adult patients admitted to a single institute for renal transplantation over a 1-year period were prospectively enrolled. A clinically predictive risk of LTBI was defined as: (i) recent close contact with a person with pulmonary TB; (ii) abnormal chest radiography; (iii) a history of untreated or inadequately treated TB; or (iv) a new infection (i.e., a recent conversion of TST).
Of 209 renal recipients, 47 (22%) had a positive TST> or =5 mm, 21 (10%) had a positive TST> or =10 mm, 65 (30%) had a positive T-SPOT.TB test, and 25 (12%) had an indeterminate T-SPOT.TB test. The induration size of TST was significantly associated with a high positivity rate on T-SPOT.TB (P<0.001). Agreement between T-SPOT.TB test and TST> or =10 mm was fair (k=0.24, 95% confidence interval 0.11-0.36). However, neither univariate nor multivariate analysis showed any association between the clinical risk for LTBI and positivity on T-SPOT.TB or TST.
T-SPOT.TB test was more frequently positive than TST in renal transplant candidates. However, further longitudinal studies are awaited to determine whether the ability of T-SPOT.TB assay to detect LTBI in renal transplant recipients can better predict the development of TB than can TST after transplantation.
Transplant Infectious Disease 04/2010; 12(2):113-9. · 2.22 Impact Factor
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S.‐H. Kim, S.‐O. Lee,
I.‐A. Park,
S.J. Park,
S.‐H. Choi,
Y.S. Kim,
J.H. Woo,
S.‐K. Park,
J.S. Park,
S.C. Kim,
D.J. Han
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ABSTRACT: S.-H. Kim, S.-O. Lee, I.-A. Park, S.J. Park, S.-H. Choi, Y.S. Kim, J.H. Woo, S.-K. Park, J.S. Park, S.C. Kim, D.J. Han. Diagnostic usefulness of a T cell-based assay for latent tuberculosis infection in kidney transplant candidates before transplantation. Transpl Infect Dis 2010: 12: 113–119. All rights reservedBackground. The presence of latent tuberculosis (TB) infection (LTBI) should be evaluated before kidney transplantation. Although a new T cell-based assay for diagnosing LTBI gave promising results, this assay has not yet been compared with the tuberculin skin test (TST) for diagnosing LTBI in renal transplant candidates before transplantation.Patients and methods. All adult patients admitted to a single institute for renal transplantation over a 1-year period were prospectively enrolled. A clinically predictive risk of LTBI was defined as: (i) recent close contact with a person with pulmonary TB; (ii) abnormal chest radiography; (iii) a history of untreated or inadequately treated TB; or (iv) a new infection (i.e., a recent conversion of TST).Results. Of 209 renal recipients, 47 (22%) had a positive TST≥5 mm, 21 (10%) had a positive TST≥10 mm, 65 (30%) had a positive T-SPOT.TB test, and 25 (12%) had an indeterminate T-SPOT.TB test. The induration size of TST was significantly associated with a high positivity rate on T-SPOT.TB (P<0.001). Agreement between T-SPOT.TB test and TST≥10 mm was fair (k=0.24, 95% confidence interval 0.11–0.36). However, neither univariate nor multivariate analysis showed any association between the clinical risk for LTBI and positivity on T-SPOT.TB or TST.Conclusion. T-SPOT.TB test was more frequently positive than TST in renal transplant candidates. However, further longitudinal studies are awaited to determine whether the ability of T-SPOT.TB assay to detect LTBI in renal transplant recipients can better predict the development of TB than can TST after transplantation.
Transplant Infectious Disease 03/2010; 12(2):113 - 119. · 2.22 Impact Factor
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S Y Park,
S-H Kim,
S-H Choi,
H Sung,
M-N Kim,
J H Woo,
Y S Kim,
S-K Park,
J-H Lee,
K-H Lee,
S-G Lee,
D J Han, S-O Lee
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ABSTRACT: Invasive pulmonary aspergillosis (IPA) is an important cause of mortality in transplant recipients and in patients with neutropenia. Although IPA has been studied extensively in neutropenic patients, there are limited data on IPA in recipients of solid organ transplants (SOTs). We compared the clinical features and radiologic findings of 27 SOT recipients with IPA with those of 35 neutropenic patients with IPA. The SOT recipients were more likely than neutropenic patients to show peribronchial consolidation (31% vs. 7%; P=0.03) or ground-glass opacity (38% vs. 7%; P=0.007) and less likely to have fever (22% vs. 80%; P<0.001), macro-nodules (35% vs. 67%; P=0.02), mass-like consolidation (27% vs. 67%; P=0.004), halo signs (8% vs. 56%; P<0.001), or air-crescent signs (0% vs. 22%; P=0.01).
Transplant Infectious Disease 02/2010; 12(4):309-15. · 2.22 Impact Factor
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S.-O. Lee,
J.H. Rim,
H. Sung,
S.-H. Kim,
S.-H. Choi,
C.W. Lee,
T.J. Yun,
J.-W. Lee,
J.H. Woo,
Y.S. Kim,
J.-J. Kim
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ABSTRACT: S.-O. Lee, J.H. Rim, H. Sung, S.-H. Kim, S.-H. Choi, C.W. Lee, T.J. Yun, J.-W. Lee, J.H. Woo, Y.S. Kim, J.-J. Kim. Comparison of higher dose and lower dose ganciclovir for cytomegalovirus prophylaxis in seropositive heart transplant recipients. Transpl Infect Dis 2010: 12: 31–37. All rights reservedBackground. We performed a retrospective historical cohort study to compare the efficacy of higher dose (HD, 10 mg/kg/day for 2 weeks, followed by 5 mg/kg/day intravenously for 2 weeks) and lower dose (LD, 5 mg/kg/day for 4 weeks) ganciclovir (GCV) for cytomegalovirus (CMV) prophylaxis in seropositive heart transplant recipients.Methods. All consecutive patients undergoing heart transplantation (HT) between June 1999 and January 2008 at our institution were enrolled. All recipients were seropositive for CMV before HT. Before October 2005, 72 patients received the HD regimen and after October 2005, 36 patients received the LD regimen. We followed up all patients for 1 year.Results. In the HD group 43 of 72 patients (60%) developed CMV infections vs. 21 of 36 patients (58%) in the LD group (P=0.89). CMV diseases occurred in 4 patients of the HD group (6%) and 4 patients of the LD group (11%) (P=0.44). The incidence of acute rejection was not significantly different between the 2 groups (14% vs. 6%; P=0.33). Among patients who completed 4-week courses of prophylaxis, 32 of 58 patients (55%) in the HD group developed CMV infections vs. 18 of 30 patients (60%) in the LD group (P=0.66). CMV diseases occurred in 3 patients of the HD group (5%) and 4 of the LD group (13%) (P=0.22). Acute rejection incidence did not differ significantly between the 2 groups (17% vs. 7%; P=0.21).Conclusions. LD GCV for CMV prophylaxis may not be inferior to the HD regimen in seropositive HT recipients.
Transplant Infectious Disease 10/2009; 12(1):31 - 37. · 2.22 Impact Factor
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S-O Lee,
J H Rim,
H Sung,
S-H Kim,
S-H Choi,
C W Lee,
T J Yun,
J-W Lee,
J H Woo,
Y S Kim,
J-J Kim
[show abstract]
[hide abstract]
ABSTRACT: We performed a retrospective historical cohort study to compare the efficacy of higher dose (HD, 10 mg/kg/day for 2 weeks, followed by 5 mg/kg/day intravenously for 2 weeks) and lower dose (LD, 5 mg/kg/day for 4 weeks) ganciclovir (GCV) for cytomegalovirus (CMV) prophylaxis in seropositive heart transplant recipients.
All consecutive patients undergoing heart transplantation (HT) between June 1999 and January 2008 at our institution were enrolled. All recipients were seropositive for CMV before HT. Before October 2005, 72 patients received the HD regimen and after October 2005, 36 patients received the LD regimen. We followed up all patients for 1 year.
In the HD group 43 of 72 patients (60%) developed CMV infections vs. 21 of 36 patients (58%) in the LD group (P=0.89). CMV diseases occurred in 4 patients of the HD group (6%) and 4 patients of the LD group (11%) (P=0.44). The incidence of acute rejection was not significantly different between the 2 groups (14% vs. 6%; P=0.33). Among patients who completed 4-week courses of prophylaxis, 32 of 58 patients (55%) in the HD group developed CMV infections vs. 18 of 30 patients (60%) in the LD group (P=0.66). CMV diseases occurred in 3 patients of the HD group (5%) and 4 of the LD group (13%) (P=0.22). Acute rejection incidence did not differ significantly between the 2 groups (17% vs. 7%; P=0.21).
LD GCV for CMV prophylaxis may not be inferior to the HD regimen in seropositive HT recipients.
Transplant Infectious Disease 10/2009; 12(1):31-7. · 2.22 Impact Factor
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ABSTRACT: There are limited data on the clinical significance of positive central venous catheter (CVC) tip cultures associated with concomitant negative blood cultures performed at the time of CVC removal. A retrospective cohort study of all patients who yielded isolated positive CVC tip cultures was conducted in a tertiary-care hospital with 2200 beds during a 10-year period. All patients with isolated positive CVC tip cultures were observed for the development of subsequent bacteraemia or fungaemia between 2 and 28 days after CVC removal. An isolated positive CVC tip culture was defined as a case in which (i) a CVC tip culture yielded > or = 15 colonies using a semiquantitative culture method and (ii) at least two sets of blood samples revealed no organism at, or close to, the time of CVC removal (48 h before to 48 h after CVC removal). During the study period, 312 patients with isolated positive CVC cultures were enrolled. Eight (2.6%; 95% CI 1.2-5.1) of the 312 patients yielding isolated bacterial or fungal CVC tip cultures developed subsequent bloodstream infection (BSI) caused by the same species as that isolated from the tip culture (Staphylococcus aureus, 1: Enterococcus spp.; 2: Pseudomonas aeruginosa; and 3: Candida spp.). Among 125 patients from whose CVC tips the above four organisms were grown, seven (12.3%) of 57 patients who did not receive appropriate antibiotic therapy within 48 h after CVC removal subsequently developed BSI, but only one (1.5%) of 68 patients who did receive appropriate therapy developed BSI (OR 0.11, p 0.02).
Clinical Microbiology and Infection 09/2009; 16(6):742-6. · 4.54 Impact Factor
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ABSTRACT: We report the first case of parainfluenza virus type 3 (PIV3) pneumonia in a kidney transplant recipient. A 39-year-old man developed pneumonia during hospitalization 6 years after kidney transplantation. He became hypoxic and underwent noninvasive ventilation. PIV3 was detected in the bronchoalveolar lavage fluid. He was treated successfully with aerosolized ribavirin and intravenous immunoglobulin. Although he recovered from pneumonia, his graft function deteriorated and he had to restart peritoneal dialysis.
Transplant Infectious Disease 07/2009; 11(4):333 - 336. · 2.22 Impact Factor
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ABSTRACT: We report the first case of parainfluenza virus type 3 (PIV3) pneumonia in a kidney transplant recipient. A 39-year-old man developed pneumonia during hospitalization 6 years after kidney transplantation. He became hypoxic and underwent noninvasive ventilation. PIV3 was detected in the bronchoalveolar lavage fluid. He was treated successfully with aerosolized ribavirin and intravenous immunoglobulin. Although he recovered from pneumonia, his graft function deteriorated and he had to restart peritoneal dialysis.
Transplant Infectious Disease 05/2009; 11(4):333-6. · 2.22 Impact Factor
