title: Relationship between cytomegalovirus and colonization of the oropharynx by gram-negative bacilli following renal transplantation.
abstract: Numerous investigators have reported an increased incidence of pneumonia caused by Gram-negative bacilli and other secondary pathogens in transplant recipients infected by cytomegalovirus (CMV). To determine if CMV infections are related to colonization of the upper respiratory tract by Gram-negative bacilli, we examined prospectively 22 renal transplant recipients with sequential bacteriological, virological and biochemical examinations performed just prior to and at various times after transplantation. Only 11% of subjects had Gram-negative bacilli isolated from gargle specimens prior to transplantation, as compared to 54% after transplantation. More importantly, after transplantation, subjects with active CMV infections were more likely to have prolonged oropharyngeal carriage of Gram-negative bacilli than subjects without CMV infections (36% v. 25%). During active CMV infections, the rate at which Gram-negative bacilli were isolated from gargle specimens rose from 28 to 47%. During culture-positive CMV infections, the isolation rate reached 57% and was significantly different from that of CMV-negative samples (P less than 0.01). The increased rate of Gram-negative bacillary isolation from gargle specimens during CMV infections was not a function of type of immunosuppressive agents used, rejection episodes, antibiotic administration, concomitant hepatitis B, Epstein-Barr (EBV) virus, or herpes simplex virus infections, or alterations in salivary fibronectin concentrations.
authors.affiliation: V.A. Medical Center, Baltimore, MD 21218.
authors.forename: P A
authors.initials: PA
authors.lastname: Mackowiak
authors.forename: M
authors.initials: M
authors.lastname: Goggans
authors.forename: W
authors.initials: W
authors.lastname: Torres
authors.forename: A
authors.initials: A
authors.lastname: Dal Nogare
authors.forename: J P
authors.initials: JP
authors.lastname: Luby
authors.forename: H
authors.initials: H
authors.lastname: Helderman
mesh_terms: D000328:Adult; D002353:Carrier State / Q000382:microbiology; D003586:Cytomegalovirus Infections / Q000150:complications*; D005260:Female; D005353:Fibronectins / Q000032:analysis / Q000378:metabolism; D006090:Gram-Negative Bacteria / Q000254:growth & development*; D016905:Gram-Negative Bacterial Infections / Q000150:complications* / Q000382:microbiology; D006801:Humans; D016030:Kidney Transplantation; D008137:Longitudinal Studies; D008297:Male; D009960:Oropharynx / Q000382:microbiology*; D011446:Prospective Studies; D012463:Saliva / Q000737:chemistry
chemical_list: D005353:Fibronectins