Donor Derived Bacterial Infections: Report From the Disease Transmission Advisory Committee (DTAC)

Background: Donor derived bacterial infections (DDBI) are an uncommon but serious complication of organ transplantation, potentially resulting in allograft loss & patient death.

Methods: The DTAC database was reviewed for cases of potential DDBI reported from 2006 to 2009. Cases were analyzed for bacterial pathogen, culture site & risk for infection, organs transplanted, antimicrobials, as well as allograft and patient outcomes. Mycobacterial infections were excluded from this analysis.

Results: 38 cases of potential DDBI were reported to DTAC. 14 cases of infection resulted in 25 recipients with transmitted DDBI. 2 donors with Ehrlichia resulted in 2/3 recipient transmission; all survived. 1 case of Legionella possibly transmitted infection to 1/6 recipients (lung only). 11 donors with pyogenic bacteria transmitted infections to 22 recipients (see Table 1); none of the affected recipients received appropriate antibiotic prophylaxis. 8 recipients expired, 2 others lost grafts; mycotic aneurysms, were common, especially with Gram negative infection. There were 16 donors with bacterial infections that did not result in transmission to 34 recipients (including 6 from pyogenic bacteria, 6 with syphilis) following receipt of appropriate antibiotics.

Conclusion: DDBI can be a significant cause of morbidity and mortality in organ transplant recipients, especially when grossly contaminated organs used or in the absence of prompt administration of appropriate prophylactic antimicrobials.