EORTC/MSGERC Definitions of Invasive Fungal Diseases: Summary of Activities of the Intensive Care Unit Working Group

Abstract The EORTC/MSGERC recently revised and updated the consensus definitions of invasive fungal disease (IFD). These definitions primarily focus on patients with cancer and stem cell or solid-organ transplant patients. They may therefore not be suitable for intensive care unit (ICU) patients. More in detail, while the definition of proven IFD applies to a broad range of hosts, the categories of probable and possible IFD were primarily designed for classical immunocompromised hosts and may therefore not be ideal for other populations. Moreover, the scope of the possible category of IFD has been diminished in the recently revised definitions for classically immunocompromised hosts. Diagnosis of IFD in the ICU presents many challenges, which are different for invasive candidiasis and for invasive aspergillosis. The aim of this article is to review progresses made in recent years and difficulties remaining in the development of definitions applicable in the ICU setting.

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Pediatric Intensive Care Unit (PICU) Utilization and Outcome in a Solid Organ Transplant Population

Pediatric Critical Care Medicine ◽

10.1097/00130478-200501000-00057 ◽

2005 ◽

Vol 6 (1) ◽

pp. 103 ◽

Cited By ~ 2

Author(s):

G E McLaughlin ◽

B G Gelman ◽

J W Kuluz ◽

M Nares ◽

G P Cantwell ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Organ Transplant ◽

Pediatric Intensive Care ◽

Solid Organ Transplant ◽

Solid Organ

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A case series of non-valvular cardiac aspergillosis in critically ill solid organ transplant and non-transplant patients and systematic review

Journal of the Intensive Care Society ◽

10.1177/1751143720936821 ◽

2020 ◽

pp. 175114372093682

Author(s):

Annalan MD Navaratnam ◽

Mohammad Al-Freah ◽

Anna Cavazza ◽

Georg Auzinger

Keyword(s):

Systematic Review ◽

Intensive Care ◽

Critically Ill ◽

High Mortality ◽

Gall Stone ◽

Solid Organ Transplantation ◽

Organ Transplant ◽

Solid Organ Transplant ◽

Solid Organ ◽

Transplant Patients

Introduction Non-valvular cardiac aspergillosis is a rare infection of the pericardium, myocardium or endocardium and is associated with a high mortality. There is a paucity of reports of non-valvular cardiac aspergillosis in critically ill and solid organ transplant (SOT) patients. The majority of cases have been reported in haemato-oncology patients, some of whom have undergone a bone marrow transplant. Objectives We describe four cases affected by non-valvular cardiac aspergillosis in the intensive care setting including a systematic review of this extremely rare infection which is associated with high mortality. Results All four-patients died but presented with varying clinical, radiological and microbiological evidence of the disease. Three patients presented following complications after solid organ transplantation, two in the context of acute liver failure and emergency liver transplant and one several years after a double lung transplant. The last patient presented with necrotising gall stone pancreatitis, multi-organ failure and subsequently a prolonged intensive care unit (ICU) stay. On review of the literature, January 1955 to July 2019, 45 cases were identified, with different risk factors, clinical and radiological manifestations, treatment regimen and outcome. Conclusion Antemortem diagnosis of cardiac aspergillosis is difficult and rare, with no cases reporting positive blood culture results. Galactomannan serology has poor sensitivity in solid organ transplant patients, further reduced by prophylactic antimicrobial treatment, which is common in the ICU setting especially post-transplant patients. Due to the scarcity of cases, treatment is extrapolated from invasive aspergillosis management, with emphasis on early treatment with combination therapy.

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SOLID ORGAN TRANSPLANT RECIPIENTS WITH PNEUMONIA IN INTENSIVE CARE UNIT: A SINGLE CENTER STUDY

Transplantation Journal ◽

10.1097/01.tp.0000698872.98640.80 ◽

2020 ◽

Vol 104 (S3) ◽

pp. S119-S119

Author(s):

Fatma Irem Yesiler ◽

Cagla Yazar ◽

Helin Sahinturk ◽

Pinar Zeyneloglu ◽

Mehmet Haberal

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Organ Transplant ◽

Solid Organ Transplant ◽

Solid Organ ◽

Transplant Recipients ◽

Single Center ◽

Single Center Study ◽

Solid Organ Transplant Recipients ◽

Center Study

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COVID-19 in 823 Transplant patients: A Systematic Scoping Review

10.1101/2021.01.18.21250025 ◽

2021 ◽

Author(s):

Moataz Maher Emara ◽

Mahmoud Elsedeiq ◽

Mohamed Elmorshedi ◽

Hamed Neamatallah ◽

Mostafa Abdelkhalek ◽

...

Keyword(s):

Acute Kidney Injury ◽

Intensive Care ◽

Clinical Presentation ◽

Organ Transplant ◽

Kidney Injury ◽

Solid Organ Transplant ◽

Solid Organ ◽

Invasive Ventilation ◽

Intensive Care Admission ◽

Transplant Patients

AbstractBackgroundManagement of COVID-19 in transplant patients is a big challenge. Data on immunosuppression management, clinical picture, and outcomes are lacking.ObjectivesTo summarize the current literature on COVID-19 in transplant patients especially the data regarding the immunosuppression protocols, clinical presentation, and outcomes.Search strategyA systematic search of MEDLINE, EBSCO, CENTRAL, CINAHL, LitCovid, Web of Science, and Scopus electronic databases. The references of the relevant studies were also searched. The search was last updated on June 3, 2020.Selection CriteriaPrimary reports of solid organ transplant patients who developed COVID-19. An overlap of cases in different reports was checked.Data collection and analysisA descriptive summary of immunosuppression therapy (before and after COVID-19), clinical presentation (symptoms, imaging, laboratory, and disease severity), management (oxygen therapy, antiviral, and antibacterial), major outcomes (Intensive care admission, invasive mechanical ventilation, acute kidney injury), and mortality.Main resultsWe identified 74 studies reporting 823 cases of solid organ transplantation with COVID-19. Among 372 patients, 114 (30.6%) were mild COVID-19, 101 (27.2%) moderate, and 157 (42.2%) severe or critical.Major outcomes included intensive care unit admission, invasive ventilation, and acute kidney injury, which occurred in 121 (14.7%), 97 (11.8%), and 63 (7.7%) of patients, respectively. Mortality was reported in 160 (19.4%) patients. Missing individual data hindered making clinical correlations.ConclusionCOVID-19 in solid organ transplant patients probably has a more disease severity, worse major outcomes (Intensive care admission, invasive ventilation, acute kidney injury), and higher mortality than in non-transplant patients.

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Management of Antimicrobial Agents in Abdominal Organ Transplant Patients in Intensive Care Unit

Current Transplantation Reports ◽

10.1007/s40472-020-00268-0 ◽

2020 ◽

Vol 7 (1) ◽

pp. 1-11

Author(s):

Aaron Kaviani ◽

Dilek Ince ◽

David A. Axelrod

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Antimicrobial Agents ◽

Organ Transplant ◽

Abdominal Organ ◽

Transplant Patients

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1103. Respiratory Virus Infections In Solid Organ Transplant Recipients: A Single Center Experience

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1289 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S581-S582

Author(s):

Maria A Mendoza ◽

Mohammed A Raja ◽

Gemma Rosello ◽

Shweta Anjan ◽

Jacques Simkins ◽

...

Keyword(s):

Intensive Care ◽

Lung Transplant ◽

Respiratory Virus ◽

Organ Transplant ◽

Solid Organ Transplant ◽

Solid Organ ◽

Transplant Recipients ◽

Virus Infections ◽

Transplant Patients ◽

Respiratory Virus Infections

Abstract Background Community acquired respiratory virus infections (RVI) are a major concern in solid organ transplant (SOT) recipients due to severe complications such as lower respiratory tract infection (LRTI), superimposed fungal and bacterial pneumonia, intensive care admission and mortality. Besides influenza and respiratory syncytial virus (RSV), there is paucity of data of RVI in SOT recipients. Table 1: Patients characteristics Table 2: Concomitant infections Methods Retrospective cohort study of a single large transplant center was performed. Data of multiplex qualitative PCR-based respiratory viral panel (RVP) samples collected between January 2017 and December 2019 were included. It is important to mention that our institution generally performs the RSV/influenza rapid detection assay as an initial test; if negative, the multiplex PCR panel is usually done. We did not include results from the RSV/influenza rapid test in this study. Results One hundred transplant patients with a single positive RVP were included (table 1). Transplanted organs include kidney (40%), followed by lung (33%) and liver (9%). Most common presenting symptoms were cough (52%), shortness of breath (28%) and rhinorrhea (26%). Of note fever was seen in only 24%. Most common RVI was Rhinovirus/Enterovirus (RHV/ENT) (59%), followed by non-SARS-CoV-2 Coronavirus (19%) and Parainfluenza (PIV) (14%). None of the patients had neutropenia, however, 52% had lymphocytopenia. Lung transplant patients developed LRTI in 70% of cases compared to non-lung transplant 64% (p=0.412). Multivariate analysis showed patients with PIV 3 were less likely to develop LRTI (p= 0.038). Significant Cytomegalovirus DNAemia (>137 IU/mL) was noted in 9.8% of the recipients. No proven or probable pulmonary fungal infection were noted within 3 months after diagnosis of RVI. Five patients were admitted to the Intensive care unit due to septic shock. Three patients died at 4, 5 and 35 days after diagnosis of RHV/ENT, PIV-3 and RHV/ENT respectively. Conclusion Most of the cases of RVI were due to RHV/ENT. Patients with PIV 3 were less likely to develop LRTI. Lung transplant recipients developed LRTI with similar incidence to non-lung recipients. Our data shows a very low mortality of 3% after RVI in our SOT cohort, which warrants larger studies. Disclosures Michele I. Morris, MD, Viracor Eurofins (Advisor or Review Panel member)

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