Article information
Abstract
The most frequent complication from infection after solid organ transplantation is bacterial infection. This complication is more frequent in organ transplantation involving the abdominal cavity, such as liver or pancreas transplantation, and less frequent in heart transplant recipients. The sources, clinical characteristics, antibiotic resistance and clinical outcomes vary according to the time of onset after transplantation. Most bacterial infections during the first month post-transplantation are hospital acquired, and there is usually a high incidence of multidrug-resistant bacterial infections. The higher incidence of complications from bacterial infection in the first month post-transplantation may be associated with high morbidity. Of special interest due to their frequency are infections by S. aureus, enterococci, Gram-negative enteric and non-fermentative bacilli. Opportunistic bacterial infections may occur at any time on the posttransplant timeline, but are more frequent between months two and six, the period in which immunosuppression is higher. The most frequent bacterial species causing opportunistic infections in organ transplant recipients are Listeria monocytogenes and Nocardia spp. After month six, posttransplantation solid organ transplant patients usually develop conventional community-acquired bacterial infections, especially urinary tract infections by E. coli and S. pneumoniae pneumonia. In this article we review the clinical characteristics, epidemiology, diagnosis and prognosis of bacterial infections in solid organ transplant patients.
Keywords:
Nosocomial bacterial infections
Multidrug resistance
Opportunistic bacterial infections
Solid organ transplantation
Resumen
La infección bacteriana es la complicación infecciosa más frecuente tras el trasplante de órgano sólido. Esta complicación es más frecuente en el trasplante de órgano que involucra la cavidad abdominal, como por ejemplo el trasplante de hígado o de páncreas, y menos frecuente en los receptores de trasplante cardíaco. Las fuentes, características clínicas, resistencia a antibiótico y resultados clínicos varían de acuerdo con el momento del comienzo de la infección tras el trasplante. Muchas infecciones bacterianas durante el primer mes tras el trasplante son adquiridas en el hospital, habitualmente asociadas con una alta incidencia de infecciones por bacterias multirresistentes. La mayor incidencia de infección bacteriana ocurre durante el primer mes tras el trasplante y esta complicación puede amenazar la vida del paciente y estar asociada a una alta mortalidad. Debido a su frecuencia son de especial interés las infecciones por S. aureus, enterococos, Gram-negativos entéricos y bacilos no fermentativos. Las infecciones bacterianas oportunistas pueden ocurrir en cualquier momento tras el trasplante, pero son más frecuentes de los 2 a los 6 meses, período en el cual la inmunosupresión es más alta. Las especies bacterianas causantes de infección oportunista en los receptores de trasplante de órgano más frecuentes son Listeria monocytogenes y Nocardia spp. Tras el sexto mes después del trasplante los pacientes sometidos a trasplante de órgano sólido habitualmente desarrollan las convencionales infecciones bacterianas adquiridas en la comunidad, especialmente infecciones del tracto urinario por E. coli y neumonía por S. pneumoniae. En este artículo revisamos las características clínicas, epidemiología, diagnóstico y pronóstico de las infecciones bacterianas en los pacientes sometidos a trasplante de órgano sólido.
Palabras clave:
Infecciones bacterianas nosocomiales
Infecciones bacterianas oportunistas
Multirresistencia
Trasplante de órgano sólido
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