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The aim was to analyze the characteristics and predictors of unfavorable outcomes in solid organ transplant recipients (SOTRs) with COVID-19. We conducted a prospective observational cohort study of 210 consecutive SOTRs hospitalized with COVID-19 in 12 Spanish centers from 21 February to 6 May 2020. Data pertaining to demographics, chronic underlying diseases, transplantation features, clinical, therapeutics, and complications were collected. The primary endpoint was a composite of intensive care unit (ICU) admission and/or death. Logistic regression analyses were performed to identify the factors associated with these unfavorable outcomes. Males accounted for 148 (70.5%) patients, the median age was 63 years, and 189 (90.0%) patients had pneumonia. Common symptoms were fever, cough, gastrointestinal disturbances, and dyspnea. The most used antiviral or host-targeted therapies included hydroxychloroquine 193/200 (96.5%), lopinavir/ritonavir 91/200 (45.5%), and tocilizumab 49/200 (24.5%). Thirty-seven (17.6%) patients required ICU admission, 12 (5.7%) suffered graft dysfunction, and 45 (21.4%) died. A shorter interval between transplantation and COVID-19 diagnosis had a negative impact on clinical prognosis. Four baseline features were identified as independent predictors of intensive care need or death: advanced age, high respiratory rate, lymphopenia, and elevated level of lactate dehydrogenase. In summary, this study presents comprehensive information on characteristics and complications of COVID-19 in hospitalized SOTRs and provides indicators available upon hospital admission for the identification of SOTRs at risk of critical disease or death, underlining the need for stringent preventative measures in the early post-transplant period This study was supported by Plan Nacional de I+D+i 2013-2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016); co-financed by European Development Regional Fund “A way to achieve Europe”, Operative Program Intelligence Growth 2014-2020. EC and JSC received grants from the Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Proyectos de Investigación sobre el SARSCoV-2 y la enfermedad COVID-19 (COV20/ 00370; COV20/00580). JSC is a researcher belonging to the program “Nicola´s Monardes”(C0059–2018), Servicio Andaluz de Salud, Junta de Andalucía, Spain. SS-A is supported by a grant from the Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Proyectos de Investigación sobre el SARS-CoV

The aim was to analyze the characteristics and predictors of unfavorable outcomes in solid organ transplant recipients (SOTRs) with COVID-19. We conducted a prospective observational cohort study of 210 consecutive SOTRs hospitalized with COVID-19 in 12 Spanish centers from 21 February to 6 May 2020. Data pertaining to demographics, chronic underlying diseases, transplantation features, clinical, therapeutics, and complications were collected. The primary endpoint was a composite of intensive care unit (ICU) admission and/or death. Logistic regression analyses were performed to identify the factors associated with these unfavorable outcomes. Males accounted for 148 (70.5%) patients, the median age was 63 years, and 189 (90.0%) patients had pneumonia. Common symptoms were fever, cough, gastrointestinal disturbances, and dyspnea. The most used antiviral or host-targeted therapies included hydroxychloroquine 193/200 (96.5%), lopinavir/ritonavir 91/200 (45.5%), and tocilizumab 49/200 (24.5%). Thirty-seven (17.6%) patients required ICU admission, 12 (5.7%) suffered graft dysfunction, and 45 (21.4%) died. A shorter interval between transplantation and COVID-19 diagnosis had a negative impact on clinical prognosis. Four baseline features were identified as independent predictors of intensive care need or death: advanced age, high respiratory rate, lymphopenia, and elevated level of lactate dehydrogenase. In summary, this study presents comprehensive information on characteristics and complications of COVID-19 in hospitalized SOTRs and provides indicators available upon hospital admission for the identification of SOTRs at risk of critical disease or death, underlining the need for stringent preventative measures in the early post-transplant period., This study was supported by Plan Nacional de I+D+i 2013-2016 and Instituto de Salud Carlos III, Subdireccio´n General de Redes y Centros de Investigacio´n Cooperativa, Ministerio de Ciencia, Innovacio´n y Universidades, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016); co-financed by European Development Regional Fund “A way to achieve Europe”, Operative Program Intelligence Growth 2014-2020. EC and JSC received grants from the Instituto de Salud Carlos III, Ministerio de Ciencia e Innovacio´n, Proyectos de Investigacio´n sobre el SARSCoV-2 y la enfermedad COVID-19 (COV20/ 00370; COV20/00580). JSC is a researcher belonging to the program “Nicola´s Monardes”(C0059–2018), Servicio Andaluz de Salud, Junta de Andalucı´a, Spain. SS-A is supported by a grant from the Instituto de Salud Carlos III, Ministerio de Ciencia e Innovacio´n, Proyectos de Investigacio´n sobre el SARS-CoV-2 y la enfermedad COVID-19 (COV20/00370).

In recent years an increase in the incidence and change in the epidemiology of enterococcal endocarditis has been observed. Likewise, given that E. faecalis is part of gut microbiota, attempts have been made to correlate the enterococcal endocarditis with colorectal lesions. However, to date, there are no studies that definitively confirm this association, so it has not been possible to make specific recommendations on management. Our objective is to analyze the epidemiology of this etiology of endocarditis in our hospital and to evaluate the possible increase in incidence of colorectal pathology in these patients. For this purpose, we have carried out a retrospective cohort study comparing epidemiological factors and the prevalence of colorectal pathology in colonoscopies performed, in 185 patients diagnosed with endocarditis for different etiologies in our hospital, of which 74 were due to E. faecalis. The results of the epidemiology of enterococcal endocarditis in our hospital correspond to the literature, with an advanced mean age, multiple comorbidities, and an early mortality rate of 23%. Regarding colorectal pathology, the results favour an increased incidence of colonic pathology in patients with enterococcal endocarditis, especially in those without an unknown source of extracolonic infection. Nevertheless, more studies with systematic colonoscopies are needed to confirm these data and determine the indication of screening for colorectal pathology in these patients. En los últimos años, se ha observado un aumento de la incidencia y ciertos cambios en la epidemiología de la endocarditis enterocócica. Así mismo, E. faecalis forma parte de la flora habitual del intestino humano y, por esta razón, se ha intentado relacionar la endocarditis por este patógeno con patología colorrectal. Sin embargo, hasta el momento actual, no existen estudios que establezcan esta asociación de forma definitiva, por lo que no se han podido realizar recomendaciones específicas en el manejo diagnostico-terapéutico. El objetivo de este trabajo es analizar la epidemiología de la endocarditis por E. faecalis en nuestro hospital y evaluar el posible aumento de incidencia de patología colorrectal en estos pacientes. Para ello hemos realizado un estudio de cohortes retrospectivo en el que se analizan los factores epidemiológicos y se compara la prevalencia de patología colorrectal en las colonoscopias realizadas, en 185 pacientes diagnosticados de endocarditis por diferentes etiologías en nuestro hospital, entre las cuales 74 fueron por E. faecalis. Los resultados de la epidemiología de la endocarditis enterocócica en nuestro hospital coinciden con la literatura, con una edad media avanzada, múltiples comorbilidades y con una mortalidad precoz del 23%. En cuanto a la patología colorrectal, los resultados apuntan hacia un aumento de incidencia de patología colónica en los pacientes con endocarditis enterocócica, especialmente en aquellos sin foco de infección extracolónico conocido. Sin embargo, se necesitan más estudios prospectivos con realización reglada de colonoscopias para confirmar estos datos y determinar la necesidad de indicación de cribado de patología colorrectal en estos pacientes.

La tuberculosis (TB) es una infección oportunista grave que puede afectar a los pacientes trasplantados de órgano sólido (TOS). La incidencia de TB es 20 a 74 veces mayor en éstos enfermos respecto a la población general, con una mortalidad alrededor del 30%. El modo de aparición más frecuente de la TB como enfermedad activa después de un trasplante suele ser debido a la reactivación de una infección tuberculosa latente (ITL) en pacientes con exposición previa. Aproximadamente, en dos tercios de los casos ocurre durante el primer año tras el trasplante. La forma clínica de presentación es frecuentemente atípica, con afectación de órganos o sistemas insospechados y difíciles de diagnosticar. No es común que haya coinfección con otros microorganismos patógenos, ya sean estos oportunistas o no, aunque podrían ocurrir. El tratamiento específico requiere un control estricto de las interacciones farmacológicas del tratamiento tuberculostático con la terapia inmunosupresora. Se ha realizado un estudio observacional, retrospectivo, de tipo descriptivo de los casos de TB en TOS del Hospital Universitario y Politécnico La Fe (Valencia) en un amplio periodo de tiempo (1979-2014). Los objetivos principales fueron determinar la incidencia de TB en pacientes trasplantados, así como conocer los hallazgos clínicos, radiológicos y microbiológicos de la misma en estos pacientes. Igualmente, se pretende conocer la respuesta al tratamiento tuberculostático, los potenciales efectos adversos y las interacciones entre este grupo de fármacos con la terapia inmunosupresosa frente al rechazo del órgano trasplantado. Así, en este trabajo se describen las características de la enfermedad tuberculosa, su tratamiento (eficacia, toxicidad e interacción farmacológica), evolución y pronóstico en una serie de 31 pacientes con TOS.