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Infectious Disease Highlights from Prague

Michele Estabrook, MD and Macé Schuurmans, MD
Infectious Diseases Council Communications Liaisons

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The increasing use of mechanical circulatory support for the failing heart was a major topic at the ISHLT meeting in Prague. The ventricular assist devices are being used increasingly for extended time periods and the risk of infection is particularly high in the early postoperative phase. Dr. JM Stulak reported that prophylactic antibiotics did not have a significant impact on the rate of driveline infections and suggested that other factors might contribute to this phenomenon. The ventricular device technology itself is related to the risk of infection and, with improved technology, there has been a trend toward reduced device-related infections, as reported by Dr. C. Guerrero-Miranda.

Dr. M. Estabrook presented the test performance of the different diagnostic assays for Clostridium difficile infection. A two step approach with an initial screen for glutamate dehydrogenase followed by a second test to detect toxin has a high negative predictive value. The treatment of C. difficile infection with fidaxomicin has been shown to be superior to vancomycin when considering the resolution of diarrhea without recurrence.

Dr. C. Kotton drew attention to a number of exotic infections in donors and recipients. Eosinophilia, "a well-travelled patient", migrant background or a febrile patient with rash should prompt us to consider less common organisms (for example Chagas disease, Dengue fever or schistosomiasis).

Dr. M.H. Nguyen reported an increased rate of CMV infection after induction with alemtuzumab (versus basiliximab) in lung transplant recipients. In patients receiving alemtuzumab and valganciclovir prophylaxis, foscarnet treatment for CMV disease was ineffective and toxic as reported by Dr L. Minces and colleagues. Furthermore, the reconstitution of CMV-specific immunity after heart transplantation is modulated by mTOR inhibition using everolimus and not by the antiviral strategy according to Dr. E. Petrisi of Bologna, Italy.

Last but not least, the group of Dr. S. Keshavjee from Toronto reported ex vivo antibiotic treatment of donor lungs that were rejected because of concerns of infection. The lungs showed a significant reduction of bacterial concentration and some evidence of improved function. The new era of lung pre-treatment for organs that otherwise would be dismissed raises hopes that some of these organs will qualify for transplantation in the near future.

Disclosure Statement: The authors have no conflicts of interest to disclose.