ID COP Research Ongoing Research Projects

ID COP Research Ongoing Research Projects

  • Impact of MDR Pseudomonas in Lung recipients with cystic fibrosis

    • Principal Investigators: Stephanie Pouch, David van Duin

    • Description: Respiratory tract colonization with Pseudomonas aeruginosa is common in lung transplant recipients and has been implicated in the development of bronchiolitis obliterans syndrome (BOS) following transplantation. The prevalence of multidrug-resistant (MDR) and pan-resistant (PR) Pseudomonas aeruginosa is highest among cystic fibrosis (CF) lung transplant recipients, and the long-term impact of MDR or PR Pseudomonas aeruginosa colonization has not been well-established in this patient population.  While several studies suggest that CF patients with MDR or PR pseudomonal colonization prior to transplant have similar rates of survival compared to individuals with CF harboring more sensitive isolates, these studies have been small and did not address other post-transplant complications, including the development of BOS.  This study aims to 1) describe the outcomes of CF-lung transplant recipients colonized with Pseudomonas aeruginosa prior to transplantation and 2) evaluate the impact of prophylactic antimicrobials and the duration of antibiotic prophylaxis on clinical and microbiologic outcomes in CF-lung transplant recipients colonized with Pseudomonas aeruginosa.

    • Participating Sites: University of Washington, Massachusetts General Hospital, University of Alberta, Nationwide Children’s Hospital, Stanford, Johns Hopkins, University of Alabama at Birmingham, University of Iowa, Ochsner Clinic Foundation, Washington University, University of Pittsburgh, Vanderbilt, University of California San Diego, UT Southwestern, University of North Carolina, Columbia University

    • Status: Data analysis and manuscript preparation

  • Prior Infection or Colonization with Carbapenem-Resistant Enterobacteriaceae is Not an Absolute Contraindication to Solid Organ Transplantation

    • Principal Investigators: Stephanie Pouch, Shirish Huprikar

    • Description: Infection with carbapenem-resistant Enterobacteriaceae (CRE) is associated with significant morbidity and mortality in hospitalized patients.  Organ transplant recipients may be at higher risk for acquisition of CRE due to repeated healthcare exposures, severity of illness, and frequent receipt of antimicrobials.  Based on the supposition that transplant recipients have the potential to become infected with organisms with which they are colonized, the potential risk of transplanting patients with a history of asymptomatic colonization and/or prior infection with CRE also remains unknown and controversial.  This study aims to describe the outcomes in organ transplant recipients with pre-transplant CRE infection or colonization.

    • Participating Sites: Mount Sinai, Columbia University, University of Sao Paolo, Albert Einstein School of Medicine, University of Pittsburgh, Cornell University, Henry Ford Medical Center, University of Colorado, University Federal de Minas Gerais, Wake Forest

    • Status: Manuscript preparation

  • Outcomes Associated with Carbapenem-Resistant Enterobacteriaceae Infection after Solid Organ Transplantation in a Multicenter Study

    • Principal Investigators: Anoma Nellore, Shirish Huprikar

    • Description: Carbapenem-resistant Enterobacteriaceae (CRE) infection is a threat to solid organ transplant (SOT) recipients and has been associated with poor outcomes in this patient population.  However, published literature has largely been limited to single center experiences.  This study aims to describe the epidemiology and outcomes associated with CRE infection in SOT recipients from a multicenter cohort.

    • Participating Sites: Mount Sinai, University of Alabama at Birmingham, University of Sao Paolo, Albert Einstein School of Medicine, Ochsner Clinic Foundation, Cornell University, Drexel University, University Federal de Minas Gerais, Henry Ford Medical Center, Wake Forest, Ohio State University, University of Michigan, Federal University of Rio de Janeiro, Yale University, Rush University

    • Status: Manuscript preparation

  • A Multicenter Retrospective Review of Outcomes after Vancomycin-Resistant Enterococcus (VRE) Infections with Daptomycin MIC>4 and 2-4 Compared to Daptomycin Susceptible VRE Infections in Adult Abdominal Solid Organ Transplant Recipients

    • Principal Investigators: Anoma Nellore, Rachel Lee

    • Description: Solid organ transplant patients are at an increased risk of developing multi-drug resistant infections secondary to their immunocompromised state and the amount of time spent in the hospital.  While daptomycin non-susceptible enterococci (DNSE) infections in liver transplant recipients appear to be associated with significant morbidity and mortality, published data have been from single centers.  In addition, there are limited data available regarding the rates, outcomes, and associated risk factors for DNSE infections in the abdominal solid organ transplant (SOT) population.  The primary objective of this study is to compare outcomes between patients with DNSE (MIC >4) or vancomycin resistant enterococci (VRE) with daptomycin MIC 2-4 with daptomycin susceptible VRE (MIC <2) after adult abdominal SOT.  The outcomes of interest include graft loss and overall mortality within one year of infection.  The secondary objective is to describe the epidemiology of DNSE infections in abdominal organ transplant recipients, including recipients of liver, kidney, small bowel, and pancreas transplants. 

    • Participating Sites: University of Alabama at Birmingham, University of Pittsburgh, University of Virginia, Swedish Medical Center, Temple University, Ochsner Clinic Foundation, Duke University, Emory University

    • Status: Data collection and abstract preparation 

  • Cardiac Device Infections due to Multi-Drug Resistant Bacteria and Fungi

    • Principal Investigators: Sarah Taimur

    • Description: The use of mechanical circulatory support (MCS) as bridge to transplant (BTT) has been steadily increasing.  However, infections remain a significant cause of morbidity and mortality in patients on MCS, and the risk of death from infection increases with time spent on device support.  The outcomes associated with left ventricular assist device (LVAD) infections and microbiologic spectrum has been well studied, though there is paucity of information in the published literature on MCS infections due to multi-drug resistant bacteria (MDRO). Further, little is known about the MCS infections due to fungal pathogens.  This study aims to investigate the prevalence, microbiology, and outcomes associated with infections associated with MCS used as BTT (LVAD/BiVAD/TAH) secondary to bacteria (MDRO and non-MDRO) and fungi.

    • Participating Sites: Mount Sinai 

    • Status: Protocol and case report form development

  • A Multicenter Study on Clinical Outcomes of Infections within 200 Days of Liver Transplantation among Recipients Age 65 Years and Older

    • Principal Investigators: Maricar Malinis

    • Description: Background: Liver transplantation is increasingly performed in patients aged ≥65 years. Per the United Network for Organ Sharing data, infections are the leading primary and contributory cause of death in older liver transplant (LT) recipients. This study aims to describe the epidemiology and outcomes of infections within the first 200 days of LT in older adults. Methods: We performed a retrospective, observational multi-center study of patients aged ≥65 years who underwent primary LT from January 1, 2010 to June 30, 2015. Data collection included patient demographics, co-morbidities, transplant data, infection event in 200 days of LT and death. Severe infection was defined as the presence of sepsis, septic shock, or sepsis with multi-organ failure. Results: A total of 255 patients met inclusion criteria with median follow-up of 690 days (range 1– 2095). The mean age was 67.6 years (SD 2.4). Majority were male (67%) and white (85%). Frequent indications of LT were hepatocellular carcinoma (46%) and hepatitis C (32%). The median MELD score at the time of LT was 22 (range 6–47). Only 3% of recipients received thymoglobulin for induction. Acute rejection within 200 days of LT occurred in 31 (12%); graft failure in 8 (3%); and re-transplantation in 5 (2%). One hundred twenty-seven patients (50%) developed 274 infections; 63 (25%) had 1 infection and 64 (25%) had ≥ 2 infections. Median time to first infection after LT was 26 days [IQR 9–72]. Out of 274 infections, 182 (66%) occurred in <90 days. Severe infection occurred in 40/127 (31%). Cystitis (16%), colitis (12%), and pneumonia (11%) were common. Bacterial, viral, and fungal infections were 61%, 22%, and 7%, respectively. Common bacterial pathogens were Enterococcus sp. (15%), Clostridium difficile (12%) and E. coli (8%). Thirty-five (13%) opportunistic infections (OI) occurred due to Cytomegalovirus [CMV] (26), Candida (4), Cryptococcus (3), HHV-8 (1), and Aspergillus (1). Mortality due to infection was 3%, while all-cause mortality was 12%. Frequency of discharge to sub-acute or extended care facility after infection was 23%. Conclusion: Infections are common in this older LT cohort and occurred mainly in the early post-LT period. OIs were infrequent except for CMV. Despite concerns for immunosuppression and immunosenescence, the outcome of infection within the 200 days of LT was overall favorable.

    • Participating Sites: Yale School of Medicine, Johns Hopkins University, University of Alabama at Birmingham, University of Minnesota, Icahn School of Medicine at Mount Sinai, Ochsner Health System, UT Southwestern Medical Center, Ohio State University, University of Kansas, University of Chicago, University Hospital-Zurich, Drexel University, Medical University of South Carolina, University of Pittsburgh, Vanderbilt University.

    • Status: Manuscript Preparation