2013 - ISBTS 2013 Symposium

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Posters and Exhibition

15.24 - Prevalence of resident microbial pathogens post small bowel transplant

Presenter: Rui, Gao, , United Kingdom
Authors: Rui Gao¹, Thomas Glover², Rahul Chattopadhyay², Chung Thong Lim¹, Mico Chan³, Charlotte Pither¹, Lisa Sharkey¹, Bridget Chukualim¹, Andrew Butler¹, Stephen Middleton¹

Prevalence of resident microbial pathogens post small bowel transplant

Rui Gao¹, Thomas Glover², Rahul Chattopadhyay², Chung Thong Lim¹, Mico Chan³, Charlotte Pither¹, Lisa Sharkey¹, Bridget Chukualim¹, Andrew Butler¹, Stephen Middleton¹

¹Intestinal Failure and Transplantation Unit, Addenbrookes Hospital, Cambridge, United Kingdom; ²Clinical School, Addenbrookes Hospital, Cambridge, United Kingdom; ³University of New South Wales, Sydney, Australia

Background:

Knowledge on the pattern of infections post-small bowel transplantation (SBT) is still limited. The aim of this analysis was to assess the timing and incidence of pathogens in patients following SBT.

Methods:

The microbiological history of 26 patients who underwent SBT in this centre between Sep 1996 and Dec 2012 were retrospectively evaluated to identify the type and frequency of potentially pathogenic micro-organisms.

Results:

Of the 26 patients, 19 underwent 22 multi-visceral transplant, 4 had small bowel transplant, 2 had modified multi-visceral transplant and 1 had small bowel with liver transplant. Mean age at SBT is 39.5 years (SD 10.2; range 24 to 61 years), with female:male ratio of 1.9:1.0. Mean duration of follow-up was 910 days (SD 600 days: range of 19 days to 6.1 years).

There were 459 documented pathogens identified. All 26 patients (100%) had at least one pathogen isolated. Their occurrence at 0 to 1 month, 1 to 3 months, 4 to 6 months, 6 to 12 months, 12 to 24 months and later than 24 months was 170 (37.0% of pathogens identified), 90 (19.6%), 67 (14.6%), 57 (12.4%), 54 (11.8%), 21 (4.6%) respectively. Bacterial pathogens accounted for 311 episodes (67.8%), viral 75 (16.3%), fungal 73 (15.9 %).

The commonest sites of bacterial pathogens isolated were wound swabs (16.1%), blood cultures (11.3%), nasogastric (NG) aspirate (11.3%), peritoneal drain (10.6%), skin swab (8.4%), sputum (7.7%), urine (7.1%), line or catheter culture (5.5%). The commonest bacterial organisms isolated were Coag negative Staph (12.9%), Pseudomonas aeruginosa (12.9%), enterococcus (10.7%), Staph aureus (9.7%), enterococcus faecium (7.4%), E coli (6.1%), Klebsiella (6.1%).

The commonest sites of viral pathogens isolated were blood (77.3%), stool (18.7%), bronchoalveolar lavage (4.0%). The commonest viral organisms were CMV (46.7%), EBV (28.0%), norovirus (17.3%).

The commonest sites of fungal pathogens were NG aspirate (23.3%), peritoneal drain (15.1%), sputum (11.0%), gastric aspirate (11.0%), abdominal wound swab (9.6%), blood cultures (8.2%), stoma (4.1%), line or catheter culture (2.7%). The commonest fungal organisms were Candida albicans (55.4%), yeast (not Candida albicans) 18.9%, Candida glabrata (9.5%), Candida spp (18.9%)

Conclusion:

The prevalence of microbial pathogens in patients post SBT is very high, similar to previous report from the Pittsburgh group¹. Whilst this gradually reduces with time post transplant, it is significant even after 24 months. Whilst clinically important infections are not always associated with their presence a knowledge of the potentially pathogenic resident micro-organisms should allow more appropriate and timely treatment.

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