Background:Recurrence of Clostridioides difficile infection (CDI) is frequent, particularly in patients requiring subsequent systemic antibiotics. Observational studies suggest that secondary prophylaxis with oral vancomycin (SPV) may reduce recurrence risk, but randomized evidence remains scarce. Methods:PREVAN (NCT05320068) was a phase III, double-blind, placebo-controlled randomized clinical trial conducted at a tertiary hospital in Spain. Adults with documented CDI within the previous 180 days who required hospitalization and systemic antibiotics were randomized (2:1) to receive oral vancomycin (125 mg every 6 h) or placebo for 10 days, stratified by type of index CDI episode. Primary endpoints were CDI recurrence within 60 days after end of therapy and CDI recurrence-free survival. Results:Twenty-one patients were enrolled (14 SPV; 7 placebo). Mean age was 73.5 years and 76.7% had malignancy and/or immunosuppression. CDI recurrence occurred in 5 patients (23.8%): 2 (14.3%) in the SPV group and 3 (42.9%) in the placebo group (P = 0.30). CDI recurrence-free survival at 60 days was 83% (95% CI 48-95) with SPV versus 42% (95% CI 6-77) with placebo (log-rank P = 0.09). No treatment-related serious adverse events were observed; one mild diarrhoeal event occurred in a placebo-treated patient. Conclusions:In high-risk patients with recent CDI requiring systemic antibiotics, SPV appeared safe and was associated with a clinically relevant reduction in recurrence, although the trial was underpowered. These findings support further adequately powered randomized studies to define the role of SPV in preventing CDI recurrence.

BACKGROUND:Observational studies have shown that kidney transplant (KT) recipients who are cytomegalovirus (CMV)-seropositive (R+) but lack effective CMV-specific cell-mediated immunity (CMV-CMI) are at increased risk of CMV infection. METHODS:In this quasi-experimental study, an immune-guided prevention strategy based on early CMV-CMI assessment (1-2 posttransplant weeks) was evaluated in intermediate-risk KT recipients (R+ without lymphocyte-depleting induction). CMV-CMI was measured using the QuantiFERON assay (QTF-CMV). Recipients with nonreactive QTF-CMV received antiviral prophylaxis until either CMV-CMI reconstitution or month 6, while those with reactive QTF-CMV were managed with preemptive therapy. The primary outcome was the proportion of patients who developed CMV infection during the first posttransplant year. Secondary outcomes included CMV disease, CMV DNAemia requiring preemptive therapy, rejection, vascular events, and all-cause mortality. Outcomes were compared with a prospective preintervention cohort managed by standard-of-care preemptive therapy. RESULTS:We included 91 and 100 patients in the preintervention and intervention groups, with similar baseline characteristics. One-year incidence of CMV infection was similar between both groups (48.4% versus 50.0%; odds ratio [OR], 1.07; 95% confidence interval [CI], 0.61-1.89; P = 0.820). One-year incidence of CMV disease (secondary outcome) was lower in the intervention group (9.9% versus 3.0%; OR, 0.28; 95% CI, 0.07-1.08; P = 0.064), as confirmed in the per-protocol analysis (9.9% versus 2.2%; OR, 0.20; 95% CI, 0.04-0.97; P = 0.028). CONCLUSIONS:Although the tested QTF-CMV-based immune-guided strategy did not result in a reduction in the overall occurrence of CMV infection in intermediate-risk KT recipients, the lower incidence of CMV disease observed merits further research.

Background:Bispecific antibodies (BsAbs) have revolutionized multiple myeloma (MM) treatment but are associated with infectious complications. This study aims to characterize the incidence, microbiological patterns, and risk factors for infection in this population. Methods:We conducted an observational cohort study of adult MM patients treated with BsAbs at a single center between 2020 and 2025. Clinical and microbiological features of different types of infection were analyzed. Risk factors for recurrent events were assessed by Cox regression. Results:Among 92 patients receiving 98 BsAb courses, 352 infectious episodes were identified (incidence rate: 3.20 episodes per BsAbs course-year). Most common syndromes were respiratory (71.3%) and digestive (11.9%), with predominant viral etiology (62.8%). Severe (grade ≥3) infections occurred in 45.9% of courses. Anti-BCMA BsAbs carried a higher infection risk than anti-GPRC5D therapy (aHR: 1.41, 95% CI: 1.02-1.94; P-value = 0.035). Previous BsAb exposure (aHR: 1.75, 95% CI: 1.23-2.50; P-value = 0.002), allogeneic hematopoietic stem-cell transplantation (aHR: 1.59, 95% CI: 1.12-2.26; P-value = 0.010), and development of immune effector cell-associated neurotoxicity syndrome (ICANS) (aHR: 3.23, 95% CI: 1.27-8.19; P-value = 0.001) increased the risk of infection. Intravenous immunoglobulin (IVIg) therapy was protective (aHR: 0.68, 95% CI: 0.53-0.86; P-value = 0.002). Concurrent infections were documented in only 6.8% of first episodes of cytokine release syndrome (CRS). Conclusions:BsAb therapy for MM is associated with a high infection burden, predominantly respiratory and gastrointestinal. Risk is driven by cumulative immunosuppression and therapy for ICANS, while IVIg therapy reduces this susceptibility. Infections are uncommon during CRS episodes.

Due to its high incidence, urinary tract infection (UTI) is a common cause of health resources utilization and antibiotic prescription in both outpatient and inpatient settings. The OPENIN ("Optimización de procesos clínicos para el diagnóstico y tratamiento de infecciones") Group is composed of Infectious Diseases specialists and Microbiologists and aims at generating recommendations that can contribute to improve the approach to processes with high impact on the health system based on a review of the best available evidence. The second Group meeting (held in October 2024) sought to answer the following questions: Can we optimize the syndromic and microbiological diagnosis of UTI? Is it possible to improve antibiotic treatment practices? And finally, are the different interventions (non-pharmacological measures, antibiotic prophylaxis, bacterial vaccines or probiotics, among others) effective in reducing the risk of recurrences? The present review summarizes the literature reviewed for that meeting and offers a series of expert recommendations.

BACKGROUND:Echinocandins are the first-line treatment for invasive candidiasis. Rezafungin is a novel echinocandin with improved pharmacokinetic properties that allow for once-weekly intravenous administration, offering potential advantages in complex clinical settings. OBJECTIVES:We aimed to describe our real-world experience with rezafungin for the treatment of invasive fungal disease (IFD). PATIENTS:A retrospective analysis of consecutive patients treated with rezafungin for proven IFD at our center between September 2022 and December 2025 was conducted. RESULTS:We included 13 patients (mean age: 59.4 ± 17.8 years). Main predisposing conditions included immunosuppression (53.8% [solid organ transplantation in 30.8%]), solid cancer (30.8%) and recent surgical intervention (38.5%). Most frequent Candida species were C. albicans (38.5%), C. parapsilosis (30.8%) and Nakaseomyces glabratus (15.4%). One patient had necrotizing gingival infection due to Trichoderma longibrachiatum. Main types of IFD included intravascular Candida infection (38.5%) and surgical-site and intra-abdominal candidiasis (23.1% each). Reported reasons for initiating rezafungin were the presence of fluconazole-resistant isolates (53.8%), facilitating outpatient antifungal therapy (30.8%) and avoiding anticipated drug-drug interactions with triazoles (15.4%). No patient received rezafungin as a first-line treatment and most (92.3%) had been previously exposed to other echinocandins. Rezafungin was typically initiated upon clearance of follow-up blood cultures (80.0%). Median number of weekly doses was 4.0 (interquartile range: 3.0-5.5). Clinical cure (complete or partial response) by day +30 was achieved in all evaluable patients (100.0% [12/12]), with no treatment-emergent adverse events. CONCLUSIONS:Rezafungin was effective and safe as salvage or consolidation therapy in patients with IFD, including deep-seated candidiasis.

INTRODUCTION:Infection due to cytomegalovirus (CMV) frequently complicates the course of solid organ transplantation (SOT). The use of currently available antivirals is often limited due to toxicity. Maribavir (MBV) has demonstrated efficacy in clearing CMV DNAemia, with a favorable safety profile in SOT recipients. Nevertheless, real-life experience outside the clinical trial setting is still scarce. METHODS:A retrospective observational study was conducted including adult SOT recipients who experienced CMV infection and were treated with MBV at our institution between April 2023 and March 2025. RESULTS:Nineteen episodes of CMV infection diagnosed in 16 SOT (mostly lung [57.9%] and heart [26.3%]) recipients were treated with MBV (median duration of 48 days [interquartile range: 18.5-63]), primarily as salvage therapy due to previous toxicity (36.8%) or refractoriness or resistance (31.6%). The initial dose had to be subsequently increased (to 800 or 1200mg BID) in 36.8% of episodes. Transient CMV DNAemia blips were common (21.1%) but not associated to treatment failure. Breakthrough DNAemia while on MBV occurred in 36.8% of episodes. Antiviral resistance testing was performed in four episodes, with one case (25.0%) of documented resistance to MBV and ganciclovir. Clinical response was achieved in 72.2% of episodes, and treatment failure occurred in 26.3%. Treatment-emergent adverse events were rare (10.5%). All-cause mortality was 21.1%, with no CMV-attributable deaths. CONCLUSIONS:In the present real-life experience, MBV appears to be a viable and safe alternative as salvage therapy for CMV infection in SOT recipients, although cases of clinical failure and treatment-emergent resistance were observed.

BACKGROUND:Kidney transplantation from living donors (LDs) offers benefits over donation after brain death (DBD). Whether LD independently protects against infection incidence remains unclear. METHODS:We compared posttransplant infection between LD (n = 102) and DBD (n = 401) groups in a prospective observational cohort of 503 KT recipients at a tertiary-care center. Crude and adjusted associations between donor type and infection risk were assessed using propensity score (PS) modeling and multivariable Cox regression. RESULTS:Cumulative incidence rates of overall and bacterial infection were 58.6% and 43.7%, respectively. Compared to DBD recipients, LD patients had lower crude risks for overall (hazard ratio [HR]: 0.53; 95% confidence interval [CI]: 0.39-0.74; p-value < 0.001) and bacterial infection (HR: 0.59; 95% CI: 0.41-0.87; p-value = 0.007). In PS-based models, donor type was no longer significant for overall (PS-adjusted HR: 0.78; 95% CI: 0.52-1.18; p-value = 0.244) or bacterial infection (PS-adjusted HR: 0.94, 95% CI: 0.59-1.50; p-value = 0.802). Similar effect modification appeared for secondary outcomes and adjusted multivariable models. CONCLUSION:Donor type did not independently influence posttransplant infection risk after adjustment for baseline recipient factors. Lower infection incidence in LD recipients may reflect favorable recipient- and transplant-related characteristics rather than donor-specific factors.

BACKGROUND:Chronic immunosuppression associated with certain lifestyle habits render kidney transplant (KT) recipients more susceptible to infection and cancer. We assessed the level of knowledge and adherence to safe living strategies to minimize the occurrence of posttransplant complications. METHODS:Consecutive KT recipients were offered a self-administered questionnaire covering the following areas: demographics and socioeconomic factors; generic hygiene habits; sun exposure; smoking and alcohol consumption; vaccination status; animal contact and gardening; international travelling; and food safety and habits. RESULTS:Between May 2019 and May 2021, 130 KT recipients responded the survey at a median of 61.5 posttransplant days (completion rate of 94.9%). Only 19.7% of participants visited the dentist at least every 3-6 months. Although the majority (88.5%) were aware of the need of sunscreen, only 23.3% used it throughout the year. Self-reported influenza vaccine uptake in the last session was 69.1%. Pet ownership was reported by 41.7% of participants, of which more than one-third had considered to give up the care of their animals. Gardening and international travel were uncommon. A notable proportion of participants acknowledged to consume the following products either "usually" or "often": raw or undercooked meat (12.4%), undercooked fish (24.8%), raw seafood (8.8%), homemade sausages or cured ham (51.5%), pâté or meat spreads (35.2%), and "ready-to-eat" salads (31.8%). Adherence was poorer among non-native-speaking patients and those with lower education and household incomes. CONCLUSION:There is room for improvement in health education and promotion practices among KT recipients, particularly those with potential cultural and socioeconomic barriers.

The expansion of eligibility criteria has led to an increase in the age at kidney transplantation (KT), with consequences on the infection risk. We performed a prospective single-center cohort study of 712 patients undergoing KT between 2014 and 2022. Recipient age (median: 56.6 years [interquartile range: 43.2–68.5]) was analyzed by 10-year strata and dichotomized by thresholds (≥60, ≥70, ≥75 and ≥80). Univariable and multivariable regression models were constructed to assess the incidence of overall, bacterial and opportunistic post-transplant infection. In unadjusted analyses, each 10-year-increase was associated with overall (subdistribution hazard ratio [SHR]: 1.18; 95% confidence interval [CI]: 1.11–1.26), bacterial (SHR: 1.17; 95% CI: 1.09–1.26) and opportunistic infection (SHR: 1.26; 96% CI: 1.13–1.40). All groups >50 had an increased risk of infection. After multivariable adjustment, this association remained significant for overall (adjusted SHR [aSHR] per 10-year-increase: 1.09; 95% CI: 1.02–1.18) and bacterial infection (aSHR per 10-year-increase: 1.09; 95% CI: 1.00–1.18). Recipients ≥60 exhibited higher risk of overall infection (aSHR: 1.25; 95% CI: 1.00–1.54), and recipients ≥70 higher risk of opportunistic infection (aSHR: 1.54; 95% CI: 1.02–2.32). The incidence of infection was not significantly higher for patients ≥80 years. In conclusion, infection risk after KT increases with age, notably beyond 60 years.

ABSTRACTBackgroundKidney transplant (KT) recipients at intermediate risk for cytomegalovirus (CMV) infection constitute a potential target for individualized prevention strategies informed by the CMV‐specific cell‐mediated immunity (CMV‐CMI). The optimal method for the functional assessment of CMV‐CMI in this group remains unclear.MethodsWe included 74 CMV‐seropositive KT recipients that did not receive T‐cell‐depleting induction and were managed by preemptive therapy. CMV‐CMI was monitored at baseline and months 1, 3, 6, and 12 by intracellular cytokine staining (ICS) and a interferon (IFN)‐γ‐release assay (QuantiFERON‐CMV [QTF‐CMV]). Both methods were compared for discriminative capacity (areas under the receiving operating characteristic curve [auROCs]) and diagnostic accuracy to predict protection against high‐level (≥1000 IU/mL) CMV DNAemia and/or disease.ResultsEighteen patients (24.3%) experienced high‐level CMV DNAemia or disease. There were no significant differences in the discriminative capacity to predict protection of CMV‐specific CD8+ (auROC: 0.719) and CD4+ T‐cell counts (auROC: 0.664) enumerated by ICS and IFN‐γ production measured by QTF‐CMV (auROC: 0.666). Optimal cutoff values of ≥9.8 CMV‐specific CD4+ T‐cells/µL and ≥5.7 CD8+ T‐cells/µL by ICS yielded excellent specificity (95.7% and 86.9%, respectively) and positive predictive values (PPVs) (>98.0%), but a sensitivity below 60%. A reactive QTF‐CMV (IFN‐γ ≥0.2 IU/mL) provided good sensitivity (81.6%) and PPV (92.5%), at the expense of a poor specificity (22.2%).ConclusionsThe discriminative capacity to predict immune protection against clinically relevant CMV infection among intermediate‐risk KT recipients was comparable for ICS and QTF‐CMV. A selected ICS threshold may provide better specificity than the interpretative cut‐off values currently recommended for QTF‐CMV. image

Background:Breakthrough invasive mold infections (bIMIs) are life-threatening complications in hematologic cases. Most previous studies in this field covered the whole spectrum of fungal pathogens, including yeasts, and antifungal agents. Methods:We conducted a retrospective study including all hematologic cases of patients diagnosed with a bIMI while receiving a mold-active antifungal agent at our center between January 2017 and June 2022. Results:Overall 37 patients were diagnosed with bIMI: 6 (16.2%) proven, 18 (48.6%) probable, and 13 (35.1%) possible. The highest incidence rate was found for micafungin (1.31 bIMI episodes per 1000 treatment-days), although with no significant differences across antifungal agents. Most patients (90.9%) for whom therapeutic drug monitoring was performed exhibited adequate through levels. Ten (27.0%) patients had undergone allogeneic hematopoietic stem cell transplantation. Aspergillus species was the most common pathogen in cases with microbiological identification. Regarding risk factors, 67.6% had severe neutropenia at diagnosis and 40.5% had received high-intensity chemotherapy. Rates of clinical response and attributable mortality by day +30 were 64.9% and 23.3%, respectively. Poorer performance status, higher Charlson Comorbidity index, older age, and higher C-reactive protein by day +7 were associated with 30-day attributable mortality. Conclusions:Aspergillus was the predominant pathogen in our cohort of bIMIs, with a significant proportion of episodes occurring despite adequate triazole levels. Thirty-day attributable mortality was lower than previously reported. Poorer performance status, higher comorbidity burden, and older age had a relevant role in the outcome of bIMI.

Herpesviruses are able to modulate adaptive T-cell-mediated responses to establish latency within the host. Reactivation of herpes simplex virus (HSV)-1/2 and varicella zoster virus (VZV) is a frequent and potentially serious complication among kidney transplant recipients (KTRs). The ability of clinical criteria to identify KTRs at increased risk of α-herpesvirus (HSV/VZV) infection is limited. We investigated the effect of two single nucleotide polymorphisms (SNPs) in the cytotoxic T-lymphocyte antigen 4 (CTLA4) gene in a single-center cohort of 204 KTRs. After a median follow-up of 3.1 years, 34 of them (16.7%) experienced 22 episodes of zoster and 15 episodes of HSV-1/2 infection. Homozygous carriers of the minor allele of rs231775 had a higher cumulative incidence of α-herpesvirus infection (23.5% for GG versus 7.6% for AA/AG carriers; P-value = 0.011) and a lower infection-free survival (log-rank P-value = 0.037). After multivariable adjustment by clinical factors (including use of valganciclovir prophylaxis and acute rejection as time-dependent variables), the GG genotype of CTLA4 (rs231775) SNP was associated to the study outcome (adjusted hazard ratio: 3.21; 95% confidence interval: 1.44-7.16). In conclusion, genetic polymorphisms in the co-inhibitory T-cell receptor CTLA-4 may be detrimental for the immune control of latent HSV/VZV infection in KTRs.

INTRODUCTION:The increased risk of tuberculosis (TB) reactivation in solid organ transplant recipients supports the recommendation of screening for latent tuberculosis infection (LTBI). Adherence to available screening tests has not been studied in the kidney transplant (KT) population. We aimed to assess screening compliance within the ATALANTA-DOS population study. METHODS:ATALANTA-DOS studied an intervention bundle aimed at preventing infection in KT recipients. We compared LTBI screening rates between the pre-intervention (February 2016 - September 2017) and intervention (February 2018 - September 2019) cohorts and evaluated adherence rates between the interferon-gamma release assay (IGRA) and the tuberculin skin test (TST). RESULTS:A total of 307 KT recipients were included (155 in the pre-intervention cohort; 148 in the intervention cohort). A systematic assessment of screening compliance by an infectious disease specialist on day +30 post-KT improved LTBI screening adherence (82.6% [114/138] vs 1.3% [2/155]; p-value <0.001). In the intervention cohort, compliance was higher with IGRA (83.3% [52/62]) than with TST (68.1% [49/72]). Two cases of LTBI were detected in the pre-intervention cohort and five in the intervention cohort (4.4% [5/114]). All patients completed LTBI treatment after ruling out active TB. No cases of active TB were identified during follow-up. CONCLUSIONS:Systematic evaluation of LTBI screening compliance significantly increased screening completion rates among KT recipients. IGRA-based strategies increased screening compliance, supporting their implementation over TST for LTBI screening among KT recipients. Increased adherence would allow a more targeted and effective treatment of LTBI.

BACKGROUND:The presence of bacteremia is described as a cause of false-positive (FP) elevation of serum (1→3)-β-D-glucan (BDG) levels measured with the Fungitell colorimetric assay. The experience with the increasingly used turbidimetric Wako BDG assay in this scenario is limited. METHODS:We recruited 58 patients with proven bacteremia and no clinical suspicion of invasive fungal disease between October 2022 and July 2023. Serum BDG was assessed by the Wako test in blood samples collected immediately upon the confirmation of blood culture positivity (median interval of 3 days (interquartile range [IQR]: 2 - 5)). The positivity threshold was set at 7 pg/mL as per manufacturer's instructions. RESULTS:The most common sources of bacteremia were urinary tract infection (27.6%) and intraabdominal or hepatobiliary infection (24.1%). Predominant pathogens included Staphylococcus aureus (44.1%), Escherichia coli (22.0%) and Klebsiella pneumoniae (15.5%). Most of the patients (91.4%) received a β-lactam-containing regimen. A positive BDG assay was obtained in 5 patients, yielding a FP rate of 8.6% (95% confidence interval: 2.9 - 18.9). The median BDG was 8.6 pg/mL (IQR: 7-9 - 12.4). All but one patient had at least one alternative cause of FP results in the BDG assay, including hemodialysis, colitis, albumin therapy and gauze exposure. One patient with persistently elevated BDG levels was eventually diagnosed with Candida esophagitis. CONCLUSIONS:The occurrence of FP results with the turbidimetric BDG assay is uncommon, involves moderate reactivity and is typically accompanied by other potential causes of serum BDG elevation.

Multidrug-resistant (MDR) Gram-negative bacilli (GNB) infections in solid organ transplant (SOT) recipients continue to pose a significant threat despite advances in diagnostics and treatments. The last international consensus guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) on the management of MDR GNB in adult solid organ transplant (SOT) recipients were published in 2018, underscoring the need for an update to incorporate recent advances, particularly the availability of new drugs that may improve the current standard of care. A working group consisting of members from the Study Group of Infection in Transplantation and Immunocompromised Hosts (GESITRA-IC) of SEIMC, the Center for Biomedical Research Network in Infectious Diseases (CIBERINFEC) and the Spanish Society of Transplantation (SET) developed consensus-based recommendations for managing MDR GNB infections during the transplant procedure. Recommendations were categorized based on evidence quality and strength, utilizing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The final recommendations were endorsed through a consensus meeting and approved by the expert panel.

Debido a su elevada incidencia, la infección de tracto urinario (ITU) ocasiona un importante consumo de recursos y de tratamiento antibiótico en pacientes ambulantes y hospitalizados. El Grupo OPENIN («Optimización de procesos clínicos para el diagnóstico y tratamiento de infecciones»), formado por expertos en Enfermedades Infecciosas y Microbiología, pretende generar recomendaciones que contribuyan a mejorar el abordaje de procesos con elevado impacto sobre el sistema sanitario a partir de una revisión crítica de la evidencia disponible. La segunda reunión del Grupo (celebrada en octubre de 2024) trató de contestar las siguientes preguntas: ¿Podemos optimizar el diagnóstico sindrómico y etiológico de la ITU? ¿Es posible mejorar las prácticas de tratamiento antibiótico? Y, por último, ¿son eficaces las diferentes intervenciones (medidas no farmacológicas, profilaxis antibiótica, vacunas bacterianas o probióticos, entre otras) para reducir las recurrencias? Esta revisión sintetiza la literatura analizada en aquella ocasión y ofrece una serie de recomendaciones de expertos.

ABSTRACTThe impact of human cytomegalovirus (HCMV) infection on the mid‐ and long‐term balance between pro‐inflammatory and anti‐inflammatory cytokines among kidney transplant recipients (KTRs) remains unclear. We measured plasma levels of 12 Th1/Th2‐type cytokines (granulocyte‐macrophage colony‐stimulating factor, interferon‐γ, interleukin [IL]‐1β, IL‐2, IL‐4, IL‐5, IL‐6, IL‐10, IL‐12p70, IL‐13, IL‐18 and tumor necrosis factor‐α) in a cohort of 290 KTRs at four time points through month 12 after transplantation. Cytokine levels at each point were compared according to the previous documentation of HCMV replication by two approaches: “cumulative exposure” from the time of transplantation and “recent exposure” within the 2–3 months preceding cytokine assessment. Significance levels were Bonferroni‐corrected for multiple pairwise comparisons. Plasma levels of IL‐6, IL‐10, and IL‐12p70 at month 1 were significantly increased in KTRs that had experienced HCMV infection during the first 30 days. By month 3, IL‐6 and IL‐10 remained increased in KTRs with cumulative exposure through day 90. Cumulative exposure to HCMV replication through day 180 was also associated to increased IL‐10 levels at month 6. In addition, KTRs with recent HCMV exposure had increased IL‐10 levels at months 3 and 6. After multivariable adjustment, cumulative exposure to HCMV infection and/or the area under curve of HCMV DNAemia during the corresponding period were associated to IL‐10 levels within the highest quartile at months 1, 3, and 6. Preceding HCMV infection induces sustained changes in the plasma cytokine milieu of KTRs, with elevated IL‐6 and IL‐10 levels throughout the first 6 months after transplantation.

BACKGROUND:Preventive management of tuberculosis in liver transplantation (LT) is challenging due to difficulties in detecting and treating latent tuberculosis infection (LTBI). The aim of this study was to analyze the safety and efficacy of a screening strategy for LTBI with the inclusion of moxifloxacin as treatment. METHODS:We performed a retrospective single-center study of all LTs performed between 2016 and 2019 with a minimum 4-year follow-up and a standardized protocol for the evaluation of LTBI. RESULTS:Pretransplant LTBI screening was performed in 191/218 (87.6%) patients, and LTBI was diagnosed in 27.2% of them. Treatment for LTBI was administered to 71.2% of the patients and included moxifloxacin in 75.6% of the cases. After a median follow-up of 1628 days, no cases of active tuberculosis occurred among moxifloxacin-treated patients. The incidence of Clostridioides difficile (0.46 vs. 0.38 episodes/1000 transplant-days; p =  .8) and multidrug-resistant gram-negative bacilli infection (0 vs. 0.7 episodes per 1000 transplant-days; p =  .08) were not significantly higher in comparison to patients who did not receive moxifloxacin. CONCLUSION:A preventive strategy based on systematic LTBI screening and moxifloxacin treatment before LT in positive cases appears safe and effective in preventing the development of tuberculosis in LT recipients. However, our findings are limited by a small sample size; thus, larger studies are required to validate our observations.

Cytomegalovirus (CMV) infection remains a significant challenge in solid organ transplantation (SOT). The last international consensus guidelines on the management of CMV in SOT were published in 2018, highlighting the need for revision to incorporate recent advances, notably in cell-mediated immunity monitoring, which could alter the current standard of care. A working group including members from the Group for the Study of Infection in Transplantation and the Immunocompromised Host (GESITRA-IC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Spanish Society of Transplantation (SET), developed consensus-based recommendations for managing CMV infection in SOT recipients. Recommendations were classified based on evidence strength and quality using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The final recommendations were endorsed through a consensus meeting and approved by the expert panel.