tacrolimus and Liver-Abscess

Nocardiosis is usually a disseminated disease seen in immunocompromised individuals. We herein present a rare case of isolated Nocardia liver abscess post liver transplantation. The patient responded well to treatment and is on long-term antibiotics for Nocardia infection.

Topics: Anti-Bacterial Agents; End Stage Liver Disease; Glucocorticoids; Humans; Immunocompromised Host; Immunosuppression Therapy; Immunosuppressive Agents; Liver Abscess; Liver Cirrhosis, Alcoholic; Liver Transplantation; Male; Middle Aged; Mycophenolic Acid; Nocardia; Nocardia Infections; Paracentesis; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Tacrolimus; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography, Doppler; Ultrasonography, Interventional

The microbial origin, timing, risk factors, and outcome of bloodstream infections (bacteremia and fungemia) were prospectively analyzed in 130 consecutive liver transplant recipients receiving tacrolimus-based immunosuppression; median followup was 3 yr. 22% (29/130) of the patients developed 36 episodes of bloodstream infections (0.28 episodes/patient). Bloodstream infections accounted for 36% (36/100) of all major infections. 81% (29/36) of bloodstream infections were due to bacteremia and 19% (7/36) due to fungemia (candidemia 14% and cryptococcemia 5%). Intravascular catheters were the most frequent source and methicillin-resistant Staphylococcus aureus was the most frequent pathogen causing bloodstream infections. 70% of the catheter related and all bacteremias due to intra-abdominal infections occurred < or = 90 d, whereas 75% of the bacteremias due to biliary source occurred > 90 d after transplantation. Length of initial post-transplant intensive care unit stay (p = 0.014) and readmission to the intensive care unit (p = 0.003) were independently significant predictors of bloodstream infections. 40% of the candidemias occurred within 30 d of transplantation and were of unknown portal, whereas the portal in all candidemias occurring > 30 d post-transplant was known (catheter, hepatic abscess, urinary tract). Mortality in patients with bloodstream infections was 52% (15/29) vs. 9% (9/101) in patients without bloodstream infections (p = 0.0001). In conclusion, intravascular catheters (and not intra-abdominal infections) have emerged as the most common source of bloodstream infections, and gram-positive cocci (S. aureus) as the predominant pathogens in bloodstream infections after liver transplantation.

Topics: Abdomen; Adult; Aged; Bacteremia; Biliary Tract; Candidiasis; Catheterization, Peripheral; Critical Care; Cryptococcosis; Equipment Contamination; Female; Follow-Up Studies; Forecasting; Fungemia; Humans; Immunosuppressive Agents; Length of Stay; Liver Abscess; Liver Transplantation; Male; Methicillin Resistance; Middle Aged; Patient Readmission; Prospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Survival Rate; Tacrolimus; Time Factors; Treatment Outcome; Urinary Tract Infections