Chapter 126. Infections in Transplant Recipients (Part 8) potx

Infections in Transplant Recipients Part 8 Kidney Transplantation See Table 126-4 Table 126-4 Common Infections after Kidney Transplantation Period after Transplantation Infection

Chapter 126 Infections in Transplant Recipients

(Part 8)

Kidney Transplantation

(See Table 126-4)

Table 126-4 Common Infections after Kidney Transplantation

Period after Transplantation

Infection

Site

Early (<1 Month)

Middle (1–4 Months)

Late (>6 Months)

Urinary

tract

Bacteria

(Escherichia coli, Klebsiella,

Enterobacteriaceae,

Pseudomonas, Enterococcus)

associated with bacteremia and pyelonephritis;

Candida

CMV (fever, bone marrow

suppression, hepatitis); BK virus

(nephropathy, graft failure, vasculopathy)

Bacteria (late urinary tract infections usually not associated with bacteremia); BK virus (nephropathy, graft failure, generalized

vasculopathy)

(Legionella in endemic

settings)

CMV disease;

Pneumocystis;

Legionella

Nocardia;

invasive fungi

Central

nervous system

(meningitis);

Toxoplasma gondii

CMV disease;

Listeria (meningitis); Cryptococcus

(meningitis);

Nocardia

Note: CMV, cytomegalovirus

Early Infections

Bacteria often cause infections that develop in the period immediately after kidney transplantation There is a role for perioperative antibiotic prophylaxis, and many centers give cephalosporins to decrease the risk of postoperative complications Urinary tract infections developing soon after transplantation are usually related to anatomic alterations resulting from surgery Such early infections may require prolonged treatment (e.g., 6 weeks of antibiotic administration for pyelonephritis) Urinary tract infections that occur >6 months after transplantation may be treated for shorter periods because they do not seem

to be associated with the high rate of pyelonephritis or relapse seen with infections that occur in the first 3 months

Prophylaxis with TMP-SMX [1 double-strength tablet (800 mg of sulfamethoxazole, 160 mg of trimethoprim) per day] for the first 4–6 months after transplantation decreases the incidence of early and middle-period infections (see below, Table 126-4, and Table 126-5)

Table 126-5 Prophylaxis of Infections in Transplant Recipients

Risk

Factor

Organism Prophylactic

Antibiotics

Examination(s)

a

Travel

residence in

area with

known risk of

fungal

infection

Coccidioides, Histoplasma,

Blastomyces

Consider imidazoles

Chest radiography, antigen testing, serology

Latent

viruses

HSV, VZV, EBV, CMV

Acyclovir after hematopoietic

transplantation to prevent HSV and

Serologic test for HSV, VZV, CMV, HHV-6, EBV, KSHV

VZV; ganciclovir to prevent CMV in some settings

Latent

fungi and

parasites

Pneumocystis jiroveci, Toxoplasma gondii

Trimethoprim -sulfamethoxazole

atovaquone)

Serology for

Toxoplasma

Histor

y of exposure

to

tuberculosis

or latent

tuberculosis

Mycobacteriu

m tuberculosis

Isoniazid if recent conversion for positive chest imaging and/or no previous treatment

Chest imaging; PPD and/or cell-based assay

a

Serologic examination, PPD testing, and interferon assays may be less reliable after transplantation

Note: CMV, cytomegalovirus; EBV, Epstein-Barr virus; HHV-6, human

herpesvirus type 6; HSV, herpes simplex virus; KSHV, Kaposi's sarcoma– associated herpesvirus; PPD, purified protein derivative; VZV, varicella-zoster

virus