Jean-François Timsit1,2, Romain Sonneville3,4, Andre C Kalil5, Matteo Bassetti6, Ricard Ferrer7, Samir Jaber8, Fanny Lanternier9,10, Charles-Edouard Luyt11,12, Flavia Machado13, Malgorzata Mikulska14, Laurent Papazian15, Fréderic Pène16,17, Garyphalia Poulakou18, Claudio Viscoli14, Michel Wolff19, Lara Zafrani20, Christian Van Delden21. 1. Medical and Infectious Diseases ICU (MI2), APHP Bichat University Hospital, 75018, Paris, France. Jean-francois.timsit@aphp.fr. 2. Inserm IAME U1137 IAME: Decision Sciences in Infectious Diseases (DeScID), University Paris, Diderot, 75018, Paris, France. Jean-francois.timsit@aphp.fr. 3. Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, Paris Diderot University, Paris, France. 4. UMR1148, LVTS, Sorbonne Paris Cité, Inserm, Paris Diderot University, Paris, France. 5. Transplant Infectious Diseases Program, University of Nebraska Medical Center, 98500 Nebraska Medical Center, Omaha, NE, 68198, USA. 6. Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy. 7. Department of Intensive Care, Shock, Organ Dysfunction and Resuscitation Research Group (SODIR-VHIR), Vall D'Hebron University Hospital, Barcelona, Spain. 8. Anaesthesia and Critical Care Department, Saint Eloi Teaching Hospital, PhyMedExp University of Montpellier, 34295, Montpellier, France. 9. Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France. 10. Institut Pasteur, CNRS, Centre National de Référence Mycoses Invasives et Antifongiques, Unité de Mycologie Moléculaire, UMR 2000, Paris, France. 11. Médecine Intensive Réanimation, Cardiology Institute, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. 12. UPMC Université Paris 06, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Sorbonne Universités, Paris, France. 13. Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, São Paulo, Brazil. 14. Division of Infectious Diseases, University of Genova (DISSAL) and Ospedale Polyclinico San Martino, Genova, Italy. 15. Service de Médecine Intensive-Réanimation, Hôpital Nord-AP-HM, Aix-Marseille Université, Marseille, France. 16. Service de Médecine Intensive-Réanimation, Hôpital Cochin, Hôpitaux Universitaires Paris-Centre, Assistance Publique-Hôpitaux de Paris, Paris, France. 17. Institut Cochin, INSERM U1016-CNRS, UMR 8104, Université Paris Descartes, Paris, France. 18. 3rd Department of Medicine, School of Medicine, Sotiria General Hospital of Athens, Athens National and Kapodistrian University, 152 Mesogion St, 11527, Athens, Greece. 19. Service de Réanimation Neurochirurgicale, Hôpital Sainte-Anne, GHU Paris Psychiatrie & Neurosciences, 1, Rue Cabanis, 75014, Paris, France. 20. Medical ICU, Saint-Louis Hospital, AP-HP, INSERM U976, Paris Diderot University, Paris, France. 21. Transplant Infectious Diseases Unit, University Hospitals Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
Abstract
PURPOSE: Prognosis of solid organ transplant (SOT) recipients has improved, mainly because of better prevention of rejection by immunosuppressive therapies. However, SOT recipients are highly susceptible to conventional and opportunistic infections, which represent a major cause of morbidity, graft dysfunction and mortality. METHODS: Narrative review. RESULTS: We cover the current epidemiology and main aspects of infections in SOT recipients including risk factors such as postoperative risks and specific risks for different transplant recipients, key points on anti-infective prophylaxis as well as diagnostic and therapeutic approaches. We provide an up-to-date guide for management of the main syndromes that can be encountered in SOT recipients including acute respiratory failure, sepsis or septic shock, and central nervous system infections as well as bacterial infections with multidrug-resistant strains, invasive fungal diseases, viral infections and less common pathogens that may impact this patient population. CONCLUSION: We provide state-of the art review of available knowledge of critically ill SOT patients with infections.
PURPOSE: Prognosis of solid organ transplant (SOT) recipients has improved, mainly because of better prevention of rejection by immunosuppressive therapies. However, SOT recipients are highly susceptible to conventional and opportunistic infections, which represent a major cause of morbidity, graft dysfunction and mortality. METHODS: Narrative review. RESULTS: We cover the current epidemiology and main aspects of infections in SOT recipients including risk factors such as postoperative risks and specific risks for different transplant recipients, key points on anti-infective prophylaxis as well as diagnostic and therapeutic approaches. We provide an up-to-date guide for management of the main syndromes that can be encountered in SOT recipients including acute respiratory failure, sepsis or septic shock, and central nervous system infections as well as bacterial infections with multidrug-resistant strains, invasive fungal diseases, viral infections and less common pathogens that may impact this patient population. CONCLUSION: We provide state-of the art review of available knowledge of critically ill SOTpatients with infections.
Entities:
Keywords:
Immunocompromized; Outcome; Sepsis; Septic shock; Solid organ recipient
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