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Gram-Positive Bacterial Infections After Haematopoietic Stem Cell or Solid Organ Transplantation

  • Malgorzata Mikulska
  • Claudio Viscoli
Chapter

Abstract

Infections due to Gram-positive bacteria are frequent after transplantation, and they occur mainly in the early post-transplant period. Predisposing conditions include neutropenia, particularly after haematopoietic stem cell transplant (HSCT), and mechanical defence impairment related to surgery and ICU stay after solid organ transplant (SOT). Central venous catheters are involved in both settings. Bacteraemias and pneumonia are more frequent in HSCT recipients while localised infections (mediastinitis, pneumonia, cholangitis, abscesses), particularly enterococcal, are more prevalent after SOT. Coagulase-negative staphylococci, enterococci and viridans streptococci are typical Gram-positive pathogens during pre-engraftment bacteraemia after HSCT, while Staphylococcus aureus and enterococci are more frequent among SOT recipients. The mortality rate is variable, and usually lower than in Gram-negative or fungal infections. In late post-transplant phases, the risk of pneumococcal infection is high.

Although widely used, an empiric anti-Gram positive coverage should not be the rule in febrile neutropenic patients undergoing HSCT, unless specific risk factors are present. In SOT no specific rule for empirical therapy has ever been established. Antibiotic resistance is not infrequent in Gram-positive bacteria, with high rate of methicillin resistance. Fortunately, new drugs are available for treating resistant Gram-positive infections.

Keywords

Bone marrow transplant Solid organ transplant Gram positive Staphylococcus Enterococci VRE Viridans streptococci Empirical therapy Vancomycin Daptomycin Linezolid 

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© Springer International Publishing Switzerland 2016

Open Access This chapter is distributed under the terms of the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Authors and Affiliations

  1. 1.Division of Infectious Diseases, IRCCS San Martino Hospital – IST, Department of Health Sciences (DISSAL)University of GenovaGenoaItaly

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