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Infections in liver and lung transplant recipients: a national prospective cohort

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European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Infections are a major complication of solid organ transplants (SOTs). This study aimed to describe recipients’ characteristics, and the frequency and etiology of infections and transplant outcome in liver and lung SOTs, and to investigate exposures associated to infection and death in liver transplant recipients. The study population included recipients of SOTs performed in Italy during a 1-year period in ten Italian lung transplant units and eight liver transplant units. Data on comorbidities, infections, retransplantation, and death were prospectively collected using a web-based system, with a 6-month follow-up. The cumulative incidence of infection was 31.7% and 47.8% in liver and lung transplants, respectively, with most infections occurring within the first month after transplantation. Gram-negatives, which were primarily multidrug-resistant, were the most frequent cause of infection. Death rates were 0.42 per 1000 recipient-days in liver transplants and 1.41 per 1000 recipient-days in lung transplants. Infection after SOT in adult liver recipients is associated to an increased risk of death (OR = 13.25; p-value < 0.001). Given the frequency of infection caused by multidrug-resistant microorganisms in SOT recipients in Italy and the heavy impact of infections on the transplant outcome, the reinforcement of surveillance and control activities to prevent the transmission of multidrug-resistant microorganisms in SOT recipients represents a priority. The implementation of the study protocol in liver and lung transplant units and the sharing of results have increased the awareness about the threat due to antimicrobial resistance in the country.

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Funding

This study was endorsed by the Italian National Transplant Center (CNT) and supported by a grant from the Italian Ministry of Health (CCM 2012) “Prevenzione della diffusione di infezioni sostenute da microrganismi multiresistenti (MDR) in ambito trapiantologico e analisi del rischio” [13].

Author information

Authors and Affiliations

  1. Agenzia Sanitaria e Sociale Regionale Emilia-Romagna, Viale Aldo Moro 21, 40127, Bologna, Italy

    Carlo Gagliotti, Filomena Morsillo & Maria Luisa Moro

  2. Centro Nazionale Trapianti, Istituto Superiore di Sanità, Rome, Italy

    Lucia Masiero, Francesco Procaccio, Francesca Vespasiano, Andrea Ricci & Alessandro Nanni Costa

  3. Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy

    Annalisa Pantosti, Monica Monaco & Giulia Errico

  4. Clinica delle Malattie Infettive e Tropicali, Università degli studi dell’Insubria, Varese, Italy

    Paolo Grossi

Authors
  1. Carlo Gagliotti
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  2. Filomena Morsillo
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  3. Maria Luisa Moro
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  4. Lucia Masiero
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  5. Francesco Procaccio
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  6. Francesca Vespasiano
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  7. Annalisa Pantosti
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  8. Monica Monaco
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  9. Giulia Errico
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  10. Andrea Ricci
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  11. Paolo Grossi
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  12. Alessandro Nanni Costa
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Consortia

SInT Collaborative Study Group

  • D. Adorno
  • , S. Ambretti
  • , A. Amoroso
  • , M. Arghittu
  • , P. Berloco
  • , A. Bertani
  • , M. Bonizzoli
  • , P. Cambieri
  • , M. Canzonieri
  • , M. Caprio
  • , E. Carrara
  • , R. Carrinola
  • , E. Cibelli
  • , U. Cillo
  • , M. Colledan
  • , R. Colombo
  • , E. Coluccio
  • , P. G. Conaldi
  • , M. Cusi
  • , A. M. D’Armini
  • , A. Da Riva
  • , B. D’Auria
  • , L. De Carlis
  • , C. De Cillia
  • , A. De Gasperi
  • , A. Di Caro
  • , P. Di Ciaccio
  • , D. Dondossola
  • , C. Farina
  • , G. Feltrin
  • , A. C. Finarelli
  • , L. Fossati
  • , P. Gaibani
  • , A. Garcia Fernandez
  • , G. Gesu
  • , R. Giacometti
  • , F. Gona
  • , B. Gridelli
  • , L. Henrici De Angelis
  • , M. P. Landini
  • , F. Maldarelli
  • , C. Mancini
  • , P. Marone
  • , A. Mularoni
  • , G. Paglialunga
  • , P. Paladini
  • , G. Palù
  • , S. Parisi
  • , A. Peris
  • , A. D. Pinna
  • , M. Platto
  • , F. Pugliese
  • , F. Puoti
  • , C. Rago
  • , M. Ravini
  • , F. Rea
  • , M. Rinaldi
  • , G. Rossi
  • , L. Rossi
  • , M. Rossi
  • , M. Salizzoni
  • , G. Sangiorgi
  • , L. Santambrogio
  • , M. Spada
  • , V. Sparacino
  • , F. Stella
  • , R. Torelli
  • , E. Torresani
  • , D. Tosi
  • , F. Vailati
  • , M. Valeri
  • , F. Venuta
  • , S. Vesconi
  • , P. Viale
  •  & C. Vismara

Contributions

Carlo Gagliotti: wrote the manuscript. Carlo Gagliotti, Filomena Morsillo, Maria Luisa Moro, Lucia Masiero, Francesco Procaccio, Francesca Vespasiano, Annalisa Pantosti, Monica Monaco, Giulia Errico, Andrea Ricci, Paolo Antonio Grossi, Alessandro Nanni Costa, and the SInT Collaborative Study Group: provided feedback, contributed with comments, and reviewed the manuscript. Carlo Gagliotti, Filomena Morsillo, Maria Luisa Moro, Lucia Masiero, Francesco Procaccio, Francesca Vespasiano, Annalisa Pantosti, Monica Monaco, Giulia Errico, Andrea Ricci, Paolo Antonio Grossi, and Alessandro Nanni Costa: contributed to planning the study and designing the study protocol. Carlo Gagliotti and Filomena Morsillo: performed the data analysis. The SInT Collaborative Study Group: implemented the protocol and provided the study data.

Corresponding author

Correspondence to Carlo Gagliotti.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

The study protocol was approved by the Ethical Committees of the Italian Health Institute (Istituto Superiore di Sanità) and of the participating clinical centers.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Appendix

Appendix

List of the members of the SInT Collaborative Study Group:

Domenico Adorno(25) ; Simone Ambretti(7) ; Antonio Amoroso(20) ; Milena Arghittu(15c) ; Pasquale Berloco(14) ; Alessandro Bertani(16a) ; Manuela Bonizzoli(24) ; Patrizia Cambieri(17c) ; Marco Canzonieri(16) ; Mario Caprio(2) ; Elena Carrara(17a) ; Rosaria Carrinola(13b) ; Eva Cibelli(12b) ; Umberto Cillo(15b ) ; Michele Colledan(11) ; Rosaria Colombo(15c) ; Elena Coluccio(13) ; Pier Giulio Conaldi(16c) ; Mariagrazia Cusi(18) ; Andrea Maria D’Armini(17a) ; Adelaide Da Riva(15b ) ; Bianca D'Auria(14) ; Luciano De Carlis(12b) ; Carlo De Cillia(23) ; Andrea De Gasperi(12 b) ; Antonino Di Caro(6) ; Paola Di Ciaccio(2) ; Daniele Dondossola(13a) ; Claudio Farina(11 c) ; Giuseppe Feltrin(22) ; Alba Carola Finarelli(5) ; Lucina Fossati(19c) ; Paolo Gaibani(7) ; Aurora Garcia Fernandez(3) ; Giovanni Gesu(12c) ; Raffaella Giacometti(20) ; Floriana Gona(16c) ; Bruno Gridelli(16) ; Lucia Henrici De Angelis(18c) ; Maria Paola Landini(7 c) ; Federica Maldarelli(14) ; Carlo Mancini(14c) ; Piero Marone(17c) ; Alessandra Mularoni(16a) ; Giulia Paglialunga(14) ; Piero Paladini(18c) ; Giorgio Palù(8) ; Saverio Parisi(8) ; Adriano Peris(24) ; Antonio Daniele Pinna(10b) ; Marco Platto(11) ; Francesco Pugliese(14) ; Francesca Puoti(2) ; Claudio Rago(22) ; Mario Ravini(12a) ; Federico Rea(15a) ; Mauro Rinaldi(19a) ; Giorgio Rossi(13b) ; Lucia Rossi(8) ; Massimo Rossi(14b) ; Mauro Salizzoni(19b) ; Gabriela Sangiorgi(23) ; Luigi Santambrogio(13a) ; Marco Spada(16b) ; Vito Sparacino(26) ; Franco Stella(10a) ; Rosanna Torelli(21) ; Erminio Torresani(13c) ; Davide Tosi(13a) ; Francesca Vailati(11c) ; Maurizio Valeri(25) ; Federico Venuta(14a) ; Sergio Vesconi(21) ; Pierluigi Viale(9) ; Chiara Vismara(12c).

Study Coordinators:

1 Agenzia Sanitaria e Sociale Regionale Emilia-Romagna, Bologna

2 Centro Nazionale Trapianti, Istituto Superiore di Sanità, Roma

3 Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, Roma

4 Clinica delle Malattie Infettive e Tropicali, Università degli studi dell’Insubria, Varese

5 Assessorato Politiche per la Salute RER, Direzione Generale Sanità e Politiche Sociali - Servizio Sanità Pubblica, Bologna

6 Istituto Nazionale per le Malattie Infettive “L.Spallanzani” IRCCS, Roma

7 Microbiologia, Policlinico Sant’Orsola Malpighi, Bologna

8 Dipartimento di Istologia, Microbiologia e Biotecnologie Mediche, Azienda Ospedaliera –Università, Padova

9 Unità Operativa Malattie Infettive, Policlinico Sant’Orsola Malpighi, Bologna

Participating Hospitals: Lung & Liver Transplant Units, Microbiological Laboratories

10 Policlinico Sant’Orsola Malpighi, Bologna

11 A.S.S.T. Giovanni XXIII, Bergamo

12 Grande Ospedale Metropolitano, ASST Niguarda, Milano

13 I.R.C.C.S. Fondazione Ospedale Maggiore Policlinico, Milano

14 Policlinico Umberto I, Roma

15 Azienda Ospedaliera – Università, Padova

16 I.R.C.C.S. ISMETT, Palermo

17 I.R.C.C.S. Policlinico SAN Matteo, Pavia

18 Azienda Ospedaliera Universitaria, Siena

19 Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino - Presidio Molinette

(a = Lung Transplant Unit; b = Liver Transplant Unit; c = Microbiological Laboratory)

Regional Transplant Centers:

20 Centro Regionale Trapianti, Regione Piemonte, Torino

21 Centro Regionale Trapianti Regione Lombardia, Milano

22 Centro Regionale Trapianti Regione Veneto, Padova

23 Centro Regionale Trapianti Regione Emilia Romagna, Bologna

24 Centro Regionale Trapianti Regione Toscana, Firenze

25 Centro Regionale Trapianti Regione Lazio, Roma

26 Centro Regionale Trapianti Regione Sicilia, Palermo

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Gagliotti, C., Morsillo, F., Moro, M.L. et al. Infections in liver and lung transplant recipients: a national prospective cohort. Eur J Clin Microbiol Infect Dis 37, 399–407 (2018). https://doi.org/10.1007/s10096-018-3183-0

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  • DOI: https://doi.org/10.1007/s10096-018-3183-0

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