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1. Rhodomyrtone decreases Staphylococcus aureus SigB activity during exponentially growing phase and inhibits haemolytic activity within membrane vesicles

Author

Jover, A., Barcenilla, F., García, M., Pujol, M., Gasch, O., Domínguez, M.A., Camoez, M., Dueñas, C., Ojeda, E., Martínez, J.A., Marco, F., Chaves, F., Lagarde, M., López-Medrano, F., Montejo, J.M., Bereciertua, E., Hernández, J.L., von Wichmann, M.Á., Goenaga, A., García-Arenzana, J.M., Padilla, B., Padilla, C., Cercenado, E., García-Prado, G., Tapiol, J., Horcajada, J.P., Montero, M., Salvadó, M., Arnáiz, A., Fernández, C., Calbo, E., Xercavins, M., Granados, A., Fontanals, D., Pintado, V., Loza, E., Torre-Cisneros, J., Lara, R., Rodríguez-López, F., Natera, C., Blanco, J.R., Olarte, I., Benito, N., Mirelis, B., Murillas, J., Ruiz de Gopegui, E., Espejo, H., Morera, M.A., Rodríguez-Baño, J., López-Cortés, L.E., Pascual, A., Martín, C., Lepe, J.A., Molina, J., Sordé, R., Almirante, B., Larrosa, N., Mitsuwan, Watcharapong, Jiménez-Munguía, Irene, Visutthi, Monton, Sianglum, Wipawadee, Rodríguez-Ortega, Manuel J., and Voravuthikunchai, Supayang P.

Published
2019
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3. Multinational case-control study of risk factors for the development of late invasive pulmonary aspergillosis following kidney transplantation

Author

López-Medrano, F., Fernández-Ruiz, M., Silva, J.T., Carver, P.L., van Delden, C., Merino, E., Pérez-Saez, M.J., Montero, M., Coussement, J., de Abreu Mazzolin, M., Cervera, C., Santos, L., Sabé, N., Scemla, A., Cordero, E., Cruzado-Vega, L., Martín-Moreno, P.L., Len, Ó., Rudas, E., Ponce de León, A., Arriola, M., Lauzurica, R., David, M.D., González-Rico, C., Henríquez-Palop, F., Fortún, J., Nucci, M., Manuel, O., Paño-Pardo, J.R., Montejo, M., Vena, A., Sánchez-Sobrino, B., Mazuecos, A., Pascual, J., Horcajada, J.P., Lecompte, T., Moreno, A., Carratalà, J., Blanes, M., Hernández, D., Hernández-Méndez, E.A., Fariñas, M.C., Perelló-Carrascosa, M., Muñoz, P., Andrés, A., and Aguado, J.M.

Published
2018
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5. Clinical Presentation and Determinants of Mortality of Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients: A Multinational Cohort Study

Author

López-Medrano, F., Fernández-Ruiz, M., Silva, J.T., Carver, P.L., van Delden, C., Merino, E., Pérez-Saez, M.J., Montero, M., Coussement, J., de Abreu Mazzolin, M., Cervera, C., Santos, L., Sabé, N., Scemla, A., Cordero, E., Cruzado-Vega, L., Martín-Moreno, P.L., Len, ó., Rudas, E., de León, A.P., Arriola, M., Lauzurica, R., David, M., González-Rico, C., Henríquez-Palop, F., Fortún, J., Nucci, M., Manuel, O., Paño-Pardo, J.R., Montejo, M., Muñoz, P., Sánchez-Sobrino, B., Mazuecos, A., Pascual, J., Horcajada, J.P., Lecompte, T., Moreno, A., Carratalà, J., Blanes, M., Hernández, D., Fariñas, M.C., Andrés, A., and Aguado, J.M.

Published
2016
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7. Risk Factors Associated With Early Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients: Results From a Multinational Matched Case–Control Study

Author

López‐Medrano, F., Silva, J.T., Fernández‐Ruiz, M., Carver, P.L., van Delden, C., Merino, E., Pérez‐Saez, M.J., Montero, M., Coussement, J., de Abreu Mazzolin, M., Cervera, C., Santos, L., Sabé, N., Scemla, A., Cordero, E., Cruzado‐Vega, L., Martín‐Moreno, P.L., Len, Ó., Rudas, E., de León, A. Ponce, Arriola, M., Lauzurica, R., David, M., González‐Rico, C., Henríquez‐Palop, F., Fortún, J., Nucci, M., Manuel, O., Paño‐Pardo, J.R., Montejo, M., Muñoz, P., Sánchez‐Sobrino, B., Mazuecos, A., Pascual, J., Horcajada, J.P., Lecompte, T., Lumbreras, C., Moreno, A., Carratalà, J., Blanes, M., Hernández, D., Hernández‐Méndez, E.A., Fariñas, M.C., Perelló‐Carrascosa, M., Morales, J.M., Andrés, A., and Aguado, J.M.

Published
2016
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9. Risk factors, clinical features and outcomes of visceral leishmaniasis in solid-organ transplant recipients: a retrospective multicenter case–control study

Author

Clemente, W., Vidal, E., Girão, E., Ramos, A.S.D., Govedic, F., Merino, E., Muñoz, P., Sabé, N., Cervera, C., Cota, G.F., Cordero, E., Mena, A., Montejo, M., López-Medrano, F., Aguado, J.M., Fernandes, P., Valerio, M., Carratalá, J., Moreno, A., Oliveira, J., Mourão, P.H.O., and Torre-Cisneros, J.

Published
2015
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11. Lack of association between genotypes and haematogenous seeding infections in a large cohort of patients with methicillin-resistant Staphylococcus aureus bacteraemia from 21 Spanish hospitals

Author

Gasch, O., Camoez, M., Dominguez, M.A., Padilla, B., Pintado, V., Almirante, B., Martín-Gandul, C., López-Medrano, F., de Gopegui, E. Ruiz, Ramón Blanco, J., García-Pardo, G., Calbo, E., Horcajada, J.P., Granados, A., Jover-Sáenz, A., Dueñas, C., and Pujol, M.

Published
2014
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12. Regular monitoring of cytomegalovirus-specific cell-mediated immunity in intermediate-risk kidney transplant recipients: predictive value of the immediate post-transplant assessment

Author

González, E., Polanco, N., Rodríguez, R., Aranzamendi, M., Carmona, O., Escudero, R., Martín-Dávila, P., Fernández, A., Aguado, R., Vidal, E., Agüera, M.L., Rodríguez-Benot, A., Rodelo-Haad, C., Fernández-Ruiz, M., Giménez, E., Vinuesa, V., Ruiz-Merlo, T., Parra, P., Amat, P., Montejo, M., Paez-Vega, A., Cantisán, S., Torre-Cisneros, J., Fortún, J., Andrés, A., San Juan, R., López-Medrano, F., Navarro, D., and Aguado, J.M.

Published
2019
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22. Influenza vaccination during the first 6 months after solid organ transplantation is efficacious and safe

Author

Alamo, J.M., Gasch, A., Gentil-Govantes, M.A., Molina-Ortega, F.J., Lage, E., Martínez-Atienza, J., Sánchez, M., Rosso, C., Arizón, J.M., Aguera, M., Cantisán, S., Montero, J.L., Páez, A., Rodríguez, A., Santos, S., Vidal, E., Berasategui, C., Campins, M., López-Meseguer, M., Saez, B., Marcos, M.A., Sanclemente, G., Diez, N., Goikoetxea, J., Casafont, F., Cobo-Beláustegy, M., Durán, R., Fábrega-García, E., Fernández-Rozas, S., González-Rico, C., Zurbano-Goñi, F., Bodro, M., Niubó, J., Oriol, S., Sabé, N., Anaya, F., Bouza, E., Catalán, P., Diez, P., Eworo, A., Kestler, M., Lopez-Roa, P., Rincón, D., Rodríguez, M., Salcedo, M., Sousa, Y., Valerio, M., Morales-Barroso, I., Aguado, J.M., Origuen, J., Pérez-Romero, P., Bulnes-Ramos, A., Torre-Cisneros, J., Gavaldá, J., Aydillo, T.A., Moreno, A., Montejo, M., Fariñas, M.C., Carratalá, J., Muñoz, P., Blanes, M., Fortún, J., Suárez-Benjumea, A., López-Medrano, F., Barranco, J.L., Peghin, M., Roca, C., Lara, R., and Cordero, E.

Published
2015
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29. T2Candida MR as a predictor of outcome in patients with suspected invasive candidiasis starting empirical antifungal treatment: A prospective pilot study

Author

Munoz, P., Vena, A., Machado, M., Gioia, F., Martinez-Jimenez, M. C., Gomez, E., Origuen, J., Orellana, M. A., Lopez-Medrano, F., Fernandez-Ruiz, M., Merino, P., Gonzalez-Romo, F., Frias, I., Perez-Granda, M. -J., Aguado, J. M., Fortun, J., Bouza, E., Navarro, R., Sanchez, C., and Ruiz, M. F.

Subjects
0301 basic medicine, Microbiology (medical), Antifungal, Adult, Male, medicine.medical_specialty, Antifungal Agents, beta-Glucans, medicine.drug_class, 030106 microbiology, Pilot Projects, 03 medical and health sciences, Internal medicine, Clinical endpoint, Medicine, Humans, Pharmacology (medical), In patient, Blood culture, Candidiasis, Invasive, Prospective Studies, Prospective cohort study, Candida albicans, Antibodies, Fungal, Aged, Pharmacology, biology, medicine.diagnostic_test, business.industry, Candidiasis, Invasive candidiasis, Middle Aged, medicine.disease, biology.organism_classification, Magnetic Resonance Imaging, Infectious Diseases, Blood Culture, Serological biomarkers, Female, business
Abstract

Objectives We assessed the potential role of T2Candida MR (T2MR) and serological biomarkers [β-d-glucan (BDG) or Candida albicans germ tube antibodies (CAGTA)], alone or in combination with standard cultures, for identifying patients with suspected invasive candidiasis (IC), who may benefit from maintaining antifungal therapy. Methods Prospective observational multicentre study including all adult patients receiving empirical antifungal therapy for suspected IC, from January to June 2017. CAGTA, BDG and T2MR were determined at baseline and at +2 and +4 days after enrolment. Primary endpoint was the diagnostic value of CAGTA, BDG and T2MR, alone or in combination with standard culture, to predict diagnosis of IC and/or mortality in the first 7 days after starting antifungal therapy (poor outcome). Results Overall, 14/49 patients (28.6%) had a poor outcome (7 died within the first 7 days of antifungal therapy, whereas 7 ended with a diagnosis of IC). CAGTA [3/14 (21.4%) versus 8/35 (22.9%), P = 1] and BDG [8/14 (57.1%) versus 17/35 (48.6%), P = 0.75] results were similar in poor- and good-outcome patients. Conversely, a positive T2MR was associated with a higher risk of poor outcome [5/14 (35.7%) versus 0/35 (0.0%) P = 0.0001]. Specificity and positive predictive value of a positive T2MR for predicting poor outcome were both 100%, with a negative predictive value of 79.6%. After testing the combinations of biomarkers/standard cultures and T2MR/standard cultures, the combination of T2MR/standard cultures showed a high capacity to discriminate patients with poor outcome from those with good clinical evolution. Conclusions T2MR may be of significant utility to identify patients who may benefit from maintaining antifungal therapy.

Published
2018

30. The Impact of Culturing the Organ Preservation Fluid on Solid Organ Transplantation: A Prospective Multicenter Cohort Study.

Author

Oriol, I, Sabe, N, Càmara, J, Berbel, D, Ballesteros, M A, Escudero, R, Lopez-Medrano, F, Linares, L, Len, O, Silva, J T, Oliver, E, Soldevila, L, Pérez-Recio, S, Guillem, L L, Camprubí, D, LLadó, L, Manonelles, A, González-Costello, J, Domínguez, M A, and Fariñas, M C

Subjects
TRANSPLANTATION of organs, tissues, etc., ORGAN culture, GRAFT rejection, COHORT analysis, FLUIDS
Abstract

Background We analyzed the prevalence, etiology, and risk factors of culture-positive preservation fluid and their impact on the management of solid organ transplant recipients. Methods From July 2015 to March 2017, 622 episodes of adult solid organ transplants at 7 university hospitals in Spain were prospectively included in the study. Results The prevalence of culture-positive preservation fluid was 62.5% (389/622). Nevertheless, in only 25.2% (98/389) of the cases were the isolates considered "high risk" for pathogenicity. After applying a multivariate regression analysis, advanced donor age was the main associated factor for having culture-positive preservation fluid for high-risk microorganisms. Preemptive antibiotic therapy was given to 19.8% (77/389) of the cases. The incidence rate of preservation fluid–related infection was 1.3% (5 recipients); none of these patients had received preemptive therapy. Solid organ transplant (SOT) recipients with high-risk culture-positive preservation fluid receiving preemptive antibiotic therapy presented both a lower cumulative incidence of infection and a lower rate of acute rejection and graft loss compared with those who did not have high-risk culture-positive preservation fluid. After adjusting for age, sex, type of transplant, and prior graft rejection, preemptive antibiotic therapy remained a significant protective factor for 90-day infection. Conclusions The routine culture of preservation fluid may be considered a tool that provides information about the contamination of the transplanted organ. Preemptive therapy for SOT recipients with high-risk culture-positive preservation fluid may be useful to avoid preservation fluid–related infections and improve the outcomes of infection, graft loss, and graft rejection in transplant patients. [ABSTRACT FROM AUTHOR]

Published
2019
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33. Pneumonia in solid organ transplant recipients: A prospective multicenter study

Author

Giannella, M, Muñoz, P, Alarcón, Jm, Mularoni, A, Grossi, P, Bouza, E, Ranghino, Andrea, Segoloni, Giuseppe, Durante Mangoni, E, Pinto, D, Utili, R, Maiello, C, Vizzini, G, Gandolfini, I, Maggiore, U, Dalla Gasperina, D, Lappa, A, Musumeci, F, Forni, A, Faggian, G, Giaquinta, A, Veroux, P, Antonelli, B, Rossi, G, Parisi, F, Alfieri, S, Balzano, E, Filipponi, F, Valerio, F, Sandrini, S, Onano, B, Piredda, G, Frascà, Gm, Gaffi, G, Dello Strologo, L, Guzzo, I, Berardinelli, L, Pasciucco, A, Bonofiglio, R, Leone, F, Musso, M, Petrosillo, N, Lopez Medrano, F, Aguado, Jm, Charo, L, de la Torre Cisneros, J, Ulica, Ih, Moreno Camacho, A, Fernandez, Ns, Carratala, J, Eworo, A, Valerio, M, Roca, C, Cordero Matia ME, Arribi Vilela, A, Picazo de la Garza JJ, Portilla Sogorb, J, De Lucas EM, Munoz Sanz, A, Vera Tome, A, Montejo, Jm, Gurgui Ferrer, M, Mirabet, S, Canas, L, Lausturica Valdemoros, R, Silva, I, Guirado, L, Meije Castillo, Y, Fortun Abete, J, Diaz Molina, B, Bernardo Rodriguez MJ, Farinas, C, Luzano, F, and de Valdecilla, M.

Subjects
Graft Rejection, Male, Lung Diseases, Prevalence, Drug Resistance, Organ transplantation, law.invention, Solid organ transplantation, law, Drug Resistance, Multiple, Bacterial, Epidemiology, Medicine, Hospital Mortality, Prospective Studies, Viral, Prospective cohort study, education.field_of_study, Cross Infection, Incidence (epidemiology), Bacterial, Middle Aged, Intensive care unit, Community-Acquired Infections, Infectious Diseases, Fungal, Italy, Female, Multiple, medicine.medical_specialty, Critical Care, Population, Pneumonia, Viral, Health care-associated pneumonia, Internal medicine, Pneumonia, Bacterial, Humans, education, Aged, Transplantation, Lung Diseases, Fungal, business.industry, Pneumonia, Organ Transplantation, medicine.disease, Surgery, Spain, business, health care-associated pneumonia, pneumonia, solid organ transplantation
Abstract

Background Pneumonia frequently affects solid organ transplant (SOT) recipients, with high morbidity and mortality. However, the few studies on pneumonia in this population are mainly retrospective, single-center, and long-term studies, or include patients with only one type of SOT or a specific etiology. We performed a point prevalence study to investigate epidemiology, diagnosis, therapy, and outcome of pneumonia in an unselected SOT population. Methods Italian and Spanish transplant centers were invited to report on all SOT recipients with pneumonia treated during 2 separate weeks (1 each in February and June 2012). Results In total, 35 centers (18 in Italy, 17 in Spain) agreed to participate and collected 54 cases. The incidence of pneumonia was 10.1 episodes/1000 recipients/year. Pneumonia was classified as late (>6 months) in 70.4% of cases. Pneumonia was also classified as community-acquired (CAP), healthcare-associated (HCAP), and hospital-acquired (HAP) pneumonia in 40.7%, 38.9%, and 20.4% of cases, respectively. An attempt to microbiological diagnosis (≥1 sample) was made in 94.4% of patients, with a diagnostic yield of 60.7%. Causative agents included bacteria (87.1%), virus (29%), and fungi (6.4%). A multidrug-resistant bacterium was isolated in 18.2%, 40%, and 100% of patients with CAP, HCAP, and HAP (P = 0.007), respectively. Overall, 11.1% of patients were admitted to the intensive care unit, 3.7% developed graft rejection, and graft function deteriorated in 18.5%. In-hospital mortality was 1.9%. Conclusion Pneumonia remains a frequent problem in SOT recipients, although it occurs later in patients who are in better physical health. Therefore, harmful pathogens and worse outcome are less common than previously thought.

Published
2014

40. Management of cytomegalovirus infection in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations.

Author

Torre-Cisneros, J., Aguado, J.M., Caston, J.J., Almenar, L., Alonso, A., Cantisán, S., Carratalá, J., Cervera, C., Cordero, E., Fariñas, M.C., Fernández-Ruiz, M., Fortún, J., Frauca, E., Gavaldá, J., Hernández, D., Herrero, I., Len, O., Lopez-Medrano, F., Manito, N., and Marcos, M.A.

Abstract

Cytomegalovirus (CMV) infection remains a major complication of solid organ transplantation. Because of management of CMV is variable among transplant centers, in 2011 the Spanish Transplantation Infection Study Group (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) developed consensus guidelines for the prevention and treatment of CMV infection in solid organ transplant recipients. Since then, new publications have clarified or questioned the aspects covered in the previous document. For that reason, a panel of experts revised the evidence on CMV management, including immunological monitoring, diagnostics, prevention, vaccines, indirect effects, treatment, drug resistance, immunotherapy, investigational drugs, and pediatric issues. This document summarizes the recommendations. [ABSTRACT FROM AUTHOR]

Published
2016
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41. Steroid induced psychosis in systemic lupus erythematosus: a possible role of serum albumin level. (Letters)

Author

Lopez-Medrano, F, Cervera, R, Trejo, O, Font, J, and Ingelmo, M

Subjects
Steroids (Drugs) -- Case studies -- Complications and side effects, Systemic lupus erythematosus -- Drug therapy -- Case studies -- Complications and side effects, Psychoses -- Case studies -- Complications and side effects -- Drug therapy, Health
Abstract

Steroids may have diverse and sometimes severe adverse effects in the short and long term. (1) We present three patients with systemic lupus erythematosus (SLE) (2) and steroid induced psychosis [...]

Published
2002

47. Initial empirical antibiotic therapy in kidney transplant recipients with pyelonephritis: A global survey of current practice and opinions across 19 countries on six continents.

Author

Coussement J, Bansal SB, Scemla A, Svensson MHS, Barcan LA, Smibert OC, Clemente WT, Lopez-Medrano F, Hoffman T, Maggiore U, Catalano C, Hilbrands L, Manuel O, DU Toit T, Shern TKY, Chowdhury N, Viklicky O, Oberbauer R, Markowicz S, Kaminski H, Lafaurie M, Pierrotti LC, Cerqueira TL, Yahav D, Kamar N, and Kotton CN

Abstract

Background: Despite the burden of pyelonephritis after kidney transplantation, there is no consensus on initial empirical antibiotic management., Methods: We surveyed clinicians throughout the world on their practice and opinions about the initial empirical therapy of post-transplant pyelonephritis, using clinical vignettes. A panel of experts from 19 countries on six continents designed this survey, and invited 2145 clinicians to participate., Results: A total of 721 clinicians completed the survey (response rate: 34%). In the hypothetical case of a kidney transplant recipient admitted with pyelonephritis but not requiring intensive care, most respondents reported initiating either a 3rd-generation cephalosporin (37%) or piperacillin-tazobactam (21%) monotherapy. Several patient-level factors dictated the selection of broader-spectrum antibiotics, including having a recent urine culture showing growth of a resistant organism (85% for extended-spectrum ß-lactamase-producing organisms, 90% for carbapenemase-producing organisms, and 94% for Pseudomonas aeruginosa). Respondents attributed high importance to the appropriateness of empirical therapy, which 87% judged important to prevent mortality. Significant practice and opinion variations were observed between and within countries., Conclusion: High-quality studies are needed to guide the empirical management of post-transplant pyelonephritis. In particular, whether prior urine culture results should systematically be reviewed and considered remains to be determined. Studies are also needed to clarify the relationship between the appropriateness of initial empirical therapy and outcomes of post-transplant pyelonephritis., (© 2024 The Author(s). Transplant Infectious Disease published by Wiley Periodicals LLC.)

Published
2024
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49. Pre-existing Hemagglutinin Stalk Antibodies Correlate with Protection of Lower Respiratory Symptoms in Flu-Infected Transplant Patients.

Author

Aydillo T, Escalera A, Strohmeier S, Aslam S, Sanchez-Cespedes J, Ayllon J, Roca-Oporto C, Perez-Romero P, Montejo M, Gavalda J, Munoz P, Lopez-Medrano F, Carratala J, Krammer F, García-Sastre A, and Cordero E

Subjects
Adult, Aged, Animals, Cell Line, Cross Protection immunology, Cross Reactions immunology, Dogs, Female, Hemagglutination Inhibition Tests methods, Humans, Influenza A Virus, H1N1 Subtype immunology, Lower Urinary Tract Symptoms virology, Madin Darby Canine Kidney Cells, Male, Middle Aged, Neutralization Tests methods, Young Adult, Antibodies, Neutralizing immunology, Antibodies, Viral immunology, Hemagglutinins immunology, Influenza, Human immunology, Lower Urinary Tract Symptoms immunology
Abstract

Hemagglutination-inhibitory antibodies are usually highly strain specific with little effect on infection with drifted or shifted strains. The significance of broadly cross-reactive non-HAI anti-influenza antibodies against conserved domains of virus glycoproteins, such as the hemagglutinin (HA) stalk, is of great interest. We characterize a cohort of 40 H1N1pmd09 influenza-infected patients and identify lower respiratory symptoms (LRSs) as a predictor for development of pneumonia. A binomial logistic regression of log10 pre-existing antibody values shows that the probability of LRS occurrence decreased with increased anti-HA full-length and stalk antibody ELISA titers. However, a multilevel logistic regression model adjusted by other potential serocorrelates demonstrates that only antibodies directed against the stalk of HA correlate with protection from lower respiratory infection, limiting disease progression. Our predictive model indicates that a threshold of protective immunity based on broadly cross-reactive HA stalk antibodies could be feasible., Competing Interests: A.G.-S. is an inventor of patents owned by the Icahn School of Medicine at Mount Sinai in the field of influenza virus vaccines. The A.G.-S. lab has received research funds from Avimex, GSK, and 7Hills to investigate novel influenza virus vaccines. F.K. is a named inventor of technology in the field of human influenza vaccines and a named co-inventor on patents to develop chimeric HA technology to develop a universal influenza vaccine., (© 2020 The Authors.)

Published
2020
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50. A 5-Year Prospective Multicenter Evaluation of Influenza Infection in Transplant Recipients.

Author

Kumar D, Ferreira VH, Blumberg E, Silveira F, Cordero E, Perez-Romero P, Aydillo T, Danziger-Isakov L, Limaye AP, Carratala J, Munoz P, Montejo M, Lopez-Medrano F, Farinas MC, Gavalda J, Moreno A, Levi M, Fortun J, Torre-Cisneros J, Englund JA, Natori Y, Husain S, Reid G, Sharma TS, and Humar A

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Antiviral Agents therapeutic use, Canada epidemiology, Child, Child, Preschool, Female, Hospitalization statistics & numerical data, Humans, Infant, Influenza Vaccines therapeutic use, Influenza, Human drug therapy, Male, Middle Aged, Prospective Studies, Risk Factors, Spain epidemiology, United States epidemiology, Vaccination, Young Adult, Influenza, Human epidemiology, Transplant Recipients
Abstract

Background: Seasonal influenza infection may cause significant morbidity and mortality in transplant recipients. The purpose of this study was to assess the epidemiology of symptomatic influenza infection posttransplant and determine risk factors for severe disease., Methods: Twenty centers in the United States, Canada, and Spain prospectively enrolled solid organ transplant (SOT) or hematopoietic stem cell transplant (HSCT) recipients with microbiologically confirmed influenza over 5 consecutive years (2010-2015). Demographics, microbiology data, and outcomes were collected. Serial nasopharyngeal swabs were collected at diagnosis and upto 28 days, and quantitative polymerase chain reaction for influenza A was performed., Results: We enrolled 616 patients with confirmed influenza (477 SOT; 139 HSCT). Pneumonia at presentation was in 134 of 606 (22.1%) patients. Antiviral therapy was given to 94.1% for a median of 5 days (range, 1-42 days); 66.5% patients were hospitalized and 11.0% required intensive care unit (ICU) care. The receipt of vaccine in the same influenza season was associated with a decrease in disease severity as determined by the presence of pneumonia (odds ratio [OR], 0.34 [95% confidence interval {CI}, .21-.55], P < .001) and ICU admission (OR, 0.49 [95% CI, .26-.90], P = .023). Similarly, early antiviral treatment (within 48 hours) was associated with improved outcomes. In patients with influenza A, pneumonia, ICU admission, and not being immunized were also associated with higher viral loads at presentation (P = .018, P = .008, and P = .024, respectively)., Conclusions: Annual influenza vaccination and early antiviral therapy are associated with a significant reduction in influenza-associated morbidity, and should be emphasized as strategies to improve outcomes of transplant recipients.

Published
2018
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