title: Recipient-born bloodstream infection due to extensively drug-resistant Acinetobacter baumannii after emergency heart transplant: report of a case and review of the literature.
abstract: Infections due to drug-resistant Gram-negative rods are an emerging risk factor for increased mortality after solid organ transplant. Extensively drug-resistant (XDR) Acinetobacter baumannii (Acb) is a major threat in several critical care settings. The limited available data on the outcome of XDR Acb infections in organ transplant recipients mostly comes from cases of donor-derived infections. However, recipients of life-saving organs are often critically ill patients, staying long term in intensive care units, and therefore at high risk for nosocomial infections. In this report, we describe our experience with the exceedingly complex management of a recipient-born XDR Acb bloodstream infection clinically ensued shortly after heart transplant. We also review the current literature on this mounting issue relevant for intensive care, transplant medicine and infectious diseases.
authors.affiliation: Internal Medicine Section, Unit of Infectious and Transplant Medicine, Department of Cardiothoracic Sciences, AORN dei Colli, Ospedale Monaldi, University of Naples S.U.N., Via L. Bianchi 1, 80131, Naples, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Andini
authors.affiliation: Internal Medicine Section, Unit of Infectious and Transplant Medicine, Department of Cardiothoracic Sciences, AORN dei Colli, Ospedale Monaldi, University of Naples S.U.N., Via L. Bianchi 1, 80131, Naples, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Agrusta
authors.affiliation: Internal Medicine Section, Unit of Infectious and Transplant Medicine, Department of Cardiothoracic Sciences, AORN dei Colli, Ospedale Monaldi, University of Naples S.U.N., Via L. Bianchi 1, 80131, Naples, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Mattucci
authors.affiliation: Internal Medicine Section, Unit of Infectious and Transplant Medicine, Department of Cardiothoracic Sciences, AORN dei Colli, Ospedale Monaldi, University of Naples S.U.N., Via L. Bianchi 1, 80131, Naples, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Malgeri
authors.affiliation: Internal Medicine Section, Unit of Infectious and Transplant Medicine, Department of Cardiothoracic Sciences, AORN dei Colli, Ospedale Monaldi, University of Naples S.U.N., Via L. Bianchi 1, 80131, Naples, Italy.
authors.forename: Giusi
authors.initials: G
authors.lastname: Cavezza
authors.affiliation: Internal Medicine Section, Unit of Infectious and Transplant Medicine, Department of Cardiothoracic Sciences, AORN dei Colli, Ospedale Monaldi, University of Naples S.U.N., Via L. Bianchi 1, 80131, Naples, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Utili
authors.affiliation: Internal Medicine Section, Unit of Infectious and Transplant Medicine, Department of Cardiothoracic Sciences, AORN dei Colli, Ospedale Monaldi, University of Naples S.U.N., Via L. Bianchi 1, 80131, Naples, Italy. emanuele.durante@unina2.it.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Durante-Mangoni
mesh_terms: D000151:Acinetobacter Infections / Q000175:diagnosis* / Q000473:pathology; D040981:Acinetobacter baumannii / Q000187:drug effects / Q000302:isolation & purification*; D003428:Cross Infection / Q000175:diagnosis* / Q000473:pathology; D024901:Drug Resistance, Multiple, Bacterial; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D066027:Transplant Recipients
keywords: Antimicrobial chemotherapy; Colistin; Heart transplant; Immunosuppression; MDR/XDR pathogens; Prognosis
references.citation: Am J Kidney Dis. 2004 Oct;44(4):e64-7
references.pmid: 15384036
references.citation: Transpl Infect Dis. 2012 Jun;14(3):229-36
references.pmid: 22624726
references.citation: Transpl Infect Dis. 2012 Jun;14(3):292-5
references.pmid: 22093290
references.citation: Transplant Proc. 2010 May;42(4):1043-5
references.pmid: 20534219
references.citation: Antimicrob Agents Chemother. 2011 Jul;55(7):3534-7
references.pmid: 21502628
references.citation: Clin Microbiol Infect. 2012 Mar;18(3):268-81
references.pmid: 21793988
references.citation: Transpl Infect Dis. 2010 Feb;12(1):87-93
references.pmid: 19735384
references.citation: J Heart Lung Transplant. 1995 May-Jun;14(3):424-8
references.pmid: 7654726
references.citation: Antimicrob Agents Chemother. 2013 May;57(5):2103-8
references.pmid: 23422916
references.citation: J Antimicrob Chemother. 2011 May;66(5):1047-51
references.pmid: 21393131
references.citation: Transpl Infect Dis. 2012 Jun;14(3):316-20
references.pmid: 22168176
references.citation: Clin Infect Dis. 2001 Sep 1;33(5):722-6
references.pmid: 11477528
references.citation: Diagn Microbiol Infect Dis. 2010 Jun;67(2):180-4
references.pmid: 20356699
references.citation: Clin Infect Dis. 2013 Aug;57(3):349-58
references.pmid: 23616495
references.citation: Am J Transplant. 2013 Mar;13 Suppl 4:22-30
references.pmid: 23464995
references.citation: Transpl Int. 2005 Jan;17(11):680-6
references.pmid: 15565355
references.citation: Transpl Infect Dis. 2012 Jun;14(3):296-9
references.pmid: 22176504
references.citation: J Heart Lung Transplant. 2011 Apr;30(4):361-74
references.pmid: 21419994
references.citation: Transplantation. 1999 Oct 27;68(8):1107-11
references.pmid: 10551637
references.citation: Future Microbiol. 2011 Apr;6(4):407-22
references.pmid: 21526942
references.citation: Lung. 2010 Oct;188(5):381-5
references.pmid: 20607268