mycophenolic-acid and Bacteremia

The clinical course and outcomes of immunocompromised patients, such as transplant recipients, with COVID-19 remain unclear. It has been postulated that a substantial portion of the disease burden seems to be mediated by the host immune activation to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Herein, we present a simultaneous heart-kidney transplant (SHKT) recipient who was hospitalized for the management of respiratory failure from volume overload complicated by failure to thrive, multiple opportunistic infections, and open non-healing wounds in the setting of worsening renal dysfunction weeks prior to the first case of SARS-CoV-2 being detected in the state of Connecticut. After his third endotracheal intubation, routine nucleic acid testing (NAT) for SARS-CoV-2, in anticipation of a planned tracheostomy, was positive. His hemodynamics, respiratory status, and ventilator requirements remained stable without any worsening for 4 weeks until he had a negative NAT test. It is possible that the immunocompromised status of our patient may have prevented significant immune activation leading up to clinically significant cytokine storm that could have resulted in acute respiratory distress syndrome and multisystem organ failure.

Topics: Antibiotics, Antineoplastic; Bacteremia; BK Virus; Cardiomyopathy, Dilated; Cardiotoxicity; COVID-19; COVID-19 Nucleic Acid Testing; Doxorubicin; Graft Rejection; Gram-Positive Bacterial Infections; Heart Transplantation; Humans; Immunocompromised Host; Immunosuppressive Agents; Incidental Findings; Kidney Failure, Chronic; Kidney Transplantation; Male; Malnutrition; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mycophenolic Acid; Opportunistic Infections; Polyomavirus Infections; Postoperative Complications; Prednisone; Renal Dialysis; SARS-CoV-2; Staphylococcal Infections; Surgical Wound Infection; Tacrolimus; Tracheostomy; Tumor Virus Infections; Vancomycin-Resistant Enterococci; Viremia; Water-Electrolyte Imbalance

To highlight the rare but life-threatening infective consequences of immunosuppression or biologic treatment for sight-threatening uveitis.. Retrospective case series of four immunosuppressed patients with uveitis complicated by sepsis.. The affected patients were all treated using prednisolone 10 mg/day or greater, together with oral immunosuppression (2 mycophenolate mofetil, 1 azathioprine + ciclosporin, 1 methotrexate) and, in one case, infliximab. All patients survived following intensive treatment.. Life-threatening infection is a rare but important risk in immunosuppressed patients with uveitis. Complete protection is not possible and prophylaxis regimens are of unproven efficacy. Patients should understand the risks before agreeing to a course of treatment.

Topics: Adult; Aged; Azathioprine; Bacteremia; Cyclosporine; Drug Therapy, Combination; Female; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Klebsiella Infections; Male; Methotrexate; Middle Aged; Mycophenolic Acid; Pneumocystis Infections; Prednisolone; Retrospective Studies; Uveitis

Here we present a case report of a 41-year-old woman suffering from high fever and bacteremia due to Helicobacter canis, 11 months after kidney transplantation. Identification of H. canis was achieved by 16s rDNA sequence analysis of a positive blood culture. The patient was restored fully to health after antibiotics therapy (cefuroxime and ciprofloxacin). Until now, only 4 human clinical cases have been described with H. canis bacteremia. This study describes for the first time, to our knowledge, an infection with H. canis in a kidney transplant patient.

Topics: Adult; Anti-Bacterial Agents; Bacteremia; Cefuroxime; Ciprofloxacin; DNA, Bacterial; DNA, Ribosomal; Female; Graft Rejection; Helicobacter; Helicobacter Infections; Humans; Immunocompromised Host; Immunosuppressive Agents; Kidney Transplantation; Mycophenolic Acid; Prednisolone; Sequence Analysis, DNA; Tacrolimus

Topics: Antibodies, Monoclonal, Murine-Derived; Antineoplastic Combined Chemotherapy Protocols; Bacteremia; Central Nervous System Neoplasms; Drug Administration Schedule; Female; Fever; Fungemia; Humans; Immunocompromised Host; Immunosuppressive Agents; Lupus Nephritis; Lymphoma; Methotrexate; Mycophenolic Acid; Neurotoxicity Syndromes; Neutropenia; Rituximab; Treatment Outcome; Young Adult

Shewanella putrefaciens is a Gram negative opportunistic pathogen which causes skin and soft tissue infections and bacteriemia in immunocompromized patients. We report a 86-year-old man, who presented with an infectious cellulitis of the leg associated with Shewanella putrefaciens bacteriemia. This patient was treated by mycophenolate mofetil for a bullous pemphigoid resistant to corticotherapy.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents; Bacteremia; Ceftriaxone; Cellulitis; Ciprofloxacin; Dermatologic Agents; Drug Therapy, Combination; Follow-Up Studies; Gram-Negative Bacterial Infections; Humans; Immunocompromised Host; Male; Mycophenolic Acid; Pemphigoid, Bullous; Shewanella putrefaciens; Time Factors; Treatment Outcome

Bacteremia is among the known complications in simultaneous pancreas-kidney transplantation (SPKT). This study evaluated the frequency of microbial isolates and their susceptibility profiles among cultures of clinical samples obtained from blood and from the tips of blood vessel catheters of 26 SPKT recipients suspected of bacteremia in the early posttransplant period.. Data on microbiologic blood cultures of 26 adult patients undergoing SPKT were collected prospectively from 2001 to the end of 2006. The isolation and identification of cultured microorganisms were performed according to standard microbiological procedures and commercially available tests. The susceptibility of the strains to antibacterial agents was established by the Clinical and Laboratory Standards Institute guidelines.. All patients were followed prospectively for the first 4 weeks after surgery. Among 66 clinical samples, there were 23 microbial isolates from blood samples of 17 recipients and catheter tips of 12 recipients. The most common isolates were Gram-positive bacteria (73.9%) with domination of staphylococci (64.7%) and MRCNS strains (81.8%). Gram-negative bacteria comprised 17.4% of positive cultures, whereas yeast-like fungi, 8.7% with a predominance of Candida glabrata.. Our study showed predominately Gram-positive bacteria in 73.9% of isolates. The increased proportion of multi-drug-resistant bacteria and fungi to antimicrobial agents may be due to the frequent use of these agents for prophylaxis of bacterial infections in patients.

Topics: Adult; Anti-Bacterial Agents; Bacteremia; Female; Gram-Positive Bacteria; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mycophenolic Acid; Pancreas Transplantation; Postoperative Period; Retrospective Studies; Staphylococcus

Topics: Anti-Infective Agents; Bacteremia; Ciprofloxacin; Cyclosporine; Humans; Immunosuppressive Agents; Kidney Transplantation; Lung Diseases; Male; Middle Aged; Mycophenolic Acid; Prednisolone; Retreatment; Splenic Diseases; Tomography, X-Ray Computed; Yersinia pseudotuberculosis Infections

Topics: Bacteremia; Contraindications; Dermatitis, Atopic; Female; Humans; Immunosuppressive Agents; Middle Aged; Mycophenolic Acid; Staphylococcal Infections