American Journal of Transplantation
Volume 19, Issue 4, 2019, Pages 1224-1228

Transplant tourism complicated by life-threatening New Delhi metallo-β-lactamase-1 infection (Article)

Stewart J. , Snoeyenbos Newman G. , Jain R. , Bryan A. , Berger H. , Montenovo M. , Bakthavatsalam R. , Kling C.E. , Sibulesky L. , Shalhub S. , Limaye A.P. , Fisher C.E. , Rakita R.M.*
  • a Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States
  • b Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States
  • c Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States, Department of Pharmacy, University of Washington, Seattle, WA, United States
  • d Department of Laboratory Medicine, University of Washington, Seattle, WA, United States
  • e Department of Laboratory Medicine, University of Washington, Seattle, WA, United States
  • f Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, WA, United States
  • g Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, WA, United States
  • h Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, WA, United States
  • i Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, WA, United States
  • j Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA, United States
  • k Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States
  • l Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States
  • m Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States

Abstract

Transplant tourism, which is the practice of traveling to other countries for transplant, continues to be a major problem worldwide. We describe a patient who traveled to Pakistan and underwent commercial kidney transplant. He developed life-threatening infections from New Delhi metallo-β-lactamase-1–producing Enterobacter cloacae and Rhizopus oryzae, resulting in a necrotizing kidney allograft infection and subsequent external iliac artery rupture. He survived after a prolonged course of nonstandardized antimicrobial therapy, including a combination of aztreonam and ceftazidime-avibactam, and aggressive surgical debridement with allograft nephrectomy. The early timing of infection with these unusual organisms localized to the allograft suggests contamination and substandard care at the time of transplant. This case highlights the challenges of caring for these infections and serves as a cautionary tale for the potential complications of commercial transplant tourism. © 2018 The American Society of Transplantation and the American Society of Transplant Surgeons

Author Keywords

infection and infectious agents - bacterial organ sale/trade clinical research/practice infection and infectious agents - fungal complication: infectious kidney transplantation/nephrology Infectious disease organ transplantation in general antibiotic: antibacterial

Index Keywords

Pakistan dialysis Pakistani debridement thrombectomy cognitive defect non insulin dependent diabetes mellitus human extended spectrum beta lactamase producing Escherichia coli middle aged pain priority journal hypertension posaconazole Escherichia coli infection metallo beta lactamase superficial femoral artery artery rupture iliac artery limb ischemia retroperitoneal hemorrhage apparent life threatening event polymyxin B wound antifungal susceptibility femorofemoral bypass treatment duration graft infection kidney allograft New Delhi metallo beta lactamase 1 bacterial enzyme male Rhizopus oryzae case report neuromuscular blocking antifungal therapy unclassified drug Enterobacter cloacae fasciotomy graft necrosis artery ligation avibactam plus ceftazidime meropenem clinical article Enterobacteriaceae infection vancomycin Article excision drug withdrawal adult fever antibiotic therapy medical tourism aztreonam antibiotic sensitivity Nephrectomy computer assisted tomography mucormycosis chronic kidney failure add on therapy metronidazole respiratory distress postoperative pain amphotericin B lipid complex
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85055697172&doi=10.1111%2fajt.15136&partnerID=40&md5=bb534358c4f2d06a4792fe5636ae2ff8
DOI: 10.1111/ajt.15136
ISSN: 16006135
Cited by: 1
Original Language: English