Background: Among hospital-acquired infections, surgical site infections (SSIs) are frequent. SSI in the early post-transplant course poses a relevant threat to transplant recipients. Aim: To determine incidence, risk factors for SSI and its association with post-transplant outcomes and pancreas transplant (P-Tx) recipients. Methods: Adult simultaneous kidney-pancreas transplantation (SPK-T) and P-Tx recipients with a follow-up of at least 90 days were identified in the Swiss Transplant Cohort Study (STCS) dataset. Except for the categorization of SSIs according to Centers for Disease Control and Prevention (CDC) criteria, all other data were prospectively collected. Risk factors for SSI were investigated with logistic regression. A Weibull accelerated failure-time model was applied to address the impact of SSI on length of stay, correcting for transplant-related complications and delayed graft function. Findings: Of 130 transplant recipients, 108 SPK-Tx and 22 P-Tx, 18 (14%) individuals developed SSI within the first 90 days after transplantation. Deep incisional (seven, 38.9%) and organ/space infections (eight, 44.4%) predominated. In the majority of SSIs (11, 61.1%; two SSIs with simultaneous identification of fungal pathogens) bacteria were detected with Enterococcus spp. being most frequent. The median duration of hospitalization after transplantation was significantly longer in recipients with SSI (median: 26 days; interquartile range (IQR): 19-44) than in patients without SSI (median: 17 days; IQR: 12-25; P 1/4 0.002). In multivariate analysis, SSI was significantly associated with increased length of stay and prolonged the duration of hospitalization by 36% (95% confidence interval: 4-79). Conclusion: SSI after SPK-Tx and P-Tx occurred at a frequency of 14%. Among pathogens, Enterococcus spp. predominated. SSI was independently associated with a longer hospitalization after transplantation.2022 The Author(s). Published by Elsevier Ltd on behalf of The Healthcare Infection Society.

Clostridium difficile infection (CDI) is a leading cause of infectious diarrhea in solid organ transplant recipients (SOT). We aimed to assess incidence, risk factors, and outcome of CDI within the Swiss Transplant Cohort Study (STCS). We performed a case-control study of SOT recipients in the STCS diagnosed with CDI between May 2008 and August 2013. We matched 2 control subjects per case by age at transplantation, sex, and transplanted organ. A multivariable analysis was performed using conditional logistic regression to identify risk factors and evaluate outcome of CDI. Two thousand one hundred fifty-eight SOT recipients, comprising 87 cases of CDI and 174 matched controls were included. The overall CDI rate per 10 000 patient days was 0.47 (95% confidence interval ([CI] 0.38-0.58), with the highest rate in lung (1.48, 95% CI 0.93-2.24). In multivariable analysis, proven infections (hazard ratio [HR] 2.82, 95% CI 1.29-6.19) and antibiotic treatments (HR 4.51, 95% CI 2.03-10.0) during the preceding 3 months were independently associated with the development of CDI. Despite mild clinical presentations, recipients acquiring CDI posttransplantation had an increased risk of graft loss (HR 2.24, 95% CI 1.15-4.37; P = .02). These findings may help to improve the management of SOT recipients.

We assessed the impact of antiviral preventive strategies on the incidence of herpes simplex virus (HSV) and varicella-zoster virus (VZV) infections in a nationwide cohort of transplant recipients. Risk factors for the development of HSV or VZV infection were assessed by Cox proportional hazards regression. We included 2781 patients (56% kidney, 20% liver, 10% lung, 7.3% heart, 6.7% others). Overall, 1264 (45%) patients received antiviral prophylaxis (ganciclovir or valganciclovir, n = 1145; acyclovir or valacyclovir, n = 138). Incidence of HSV and VZV infections was 28.9 and 12.1 cases, respectively, per 1000 person-years. Incidence of HSV and VZV infections at 1 year after transplant was 4.6% (95% confidence interval [CI] 3.5-5.8) in patients receiving antiviral prophylaxis versus 12.3% (95% CI 10.7-14) in patients without prophylaxis; this was observed particularly for HSV infections (3% [95% CI 2.2-4] versus 9.8% [95% CI 8.4-11.4], respectively). A lower rate of HSV and VZV infections was also seen in donor or recipient cytomegalovirus-positive patients receiving ganciclovir or valganciclovir prophylaxis compared with a preemptive approach. Female sex (hazard ratio [HR] 1.663, p = 0.001), HSV seropositivity (HR 5.198, p < 0.001), previous episodes of rejection (HR 1.95, p = 0.004), and use of a preemptive approach (HR 2.841, p = 0.017) were significantly associated with a higher risk of HSV infection. Although HSV and VZV infections were common after transplantation, antiviral prophylaxis significantly reduced symptomatic HSV infections.

Introduction. New immunosuppressive agents, demographic changes in donor and recipients and prophylactic strategies are likely to impact the pattern of infections after SOT. Methods. The STCS prospectively collects data at transplantation, 6 months, and yearly thereafter in >95% of all SOT recipients in Switzerland. Validated definitions are used for infectious diseases (ID) events. Results. 1675 patients (median observation time 2 years (range 1.5 to 2.2) were included (125 heart, 1002 kidney, 43 kidney-pancreas, 335 liver, 170 lung patients). 88% had antibacterial, 53% antiviral, 14% antifungal prophylaxis. 856 patients (51%) experienced at least one of the 2113 proven ID events (PE). Bacterial infections occurred early with E. coli (568 PE, 26.9% of all PE), Klebsiella spp (158 PE, 7.5%),or P.aeruginosa (140 PE, 6.6%), or Enteroccus (290 PE, 13.7%) bloodstream and nosocomial gastrointestinal, respiratory or urinary tract infections dominating the first 120 days. Opportunistic pathogens were rare (Nocardia spp, 5 PE, 0.2%; Legionella spp, 1 PE, 0.05%; Mycobacteria, 9 PE, 0.4%; Listeria spp, 0 PE), except for Clostridium spp (89 PE, 4.2%). Viral proven events were dominated by Herpes simplex virus (98 PE, 4.6%). CMV events were rare (65 PE, 3.0%), similar to Influenza (30 PE, 1.4%), as were Parvovirus (2 PE, 0.1%), Adenovirus (9 PE,0.4%) and HHV-6/8 (1 PE, 0.05%). Early postoperative Candida spp infections were common (64 PE, 3.0%), while Aspergillus spp (18 PE, 0.8%), Zygomycetes (2 PE, 0.09%) and C. neoformans (1 PE, 0.05%) were rarely found. P. jirovecii was responsible for 21 PE, 1.0%. Conclusions. Most infectious events in our cohort are postoperative bloodstream and nosocomial infections whereas opportunistic infections are rare compared to the literature. Thus, our findings may indicate that prophylactic strategies successfully reduced opportunistic infections. Efforts to improve the early postoperative infection rate should deserve more attention.