「ブラジルにおける臓器移植後ＫＰＣ産生肺炎桿菌による死亡者の報告」について

国立感染症研究所からの国内・国外での生物学的製剤に起因する感染症に関する疫学情報が、厚生労働省を通じて、移植学会に情報提供されました。

内容：ブラジルにおける臓器移植後ＫＰＣ産生肺炎桿菌による死亡者の報告

以下のサイトは英語ではありません。
http://www.portalaz.com.br/noticia/geral/271581_orgaos_contaminados_matam_tres_transplantados_
no_rio.html;

GRAM NEGATIVE BACILLI, MULTIDRUG RESISTANT - BRAZIL (RIO DE JANEIRO)
KPC, TRANSPLANTS, FATALとして、Pro MEDにも出ています。以下ご参照下さい。

http://www.promedmail.org/direct.php?id=1822435

Infected organs transplanted kill 3 in Rio [de Janeiro]

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A total of 3 patients, who received a liver and 2 kidneys harvested at the Municipal Hospital Souza Aguiar from a woman killed in a traffic accident on 10 Jun [2013], died days after transplantation with widespread infection at 3 different hospitals.

Investigations carried out on patients and the liquid in which one kidney had been transported point to the same multidrug-resistant superbug that produced a _Klebsiella pneumoniae_ carbapenemase (KPC). In the report signed by the doctor who removed the donor's organs, the most appalling statement was inspection with free seropurulent fluid [consisting of a mixture of serum and pus] in the cavity." Thus, despite having seen pus, indicative of bacterial infection, the doctor continued with the harvesting of the organs and did communicate the fact to the 3 transplantation teams.

"The donor was hospitalized for nearly 2 months in the ICU at Souza Aguiar [there is conflicting information that the hospitalization may have lasted only 10 days - Mod.RNA]. Patients who stay for long periods in intensive care units have greater chances of being colonized by some superbug acquired in that nvironment. That alone was a warning sign. Routine examinations are done to identify patients colonized with these bacteria," says Julius Noronha, Medical Hospital Federal Bonsucesso (HFB), where a man eceived a kidney and died 7 days later.

After 5 years of waiting, a 51-year-old truck helper received in the last 12 days [June or July 2013] the ong-awaited call that could make him free of 3-times-weekly sessions on hemodialysis. After having been a chronic renal patient for 8 years, he received a kidney at the Federal Hospital Bonsucesso (HFB) [on 13 Jun 2013]. The next day [14 Jun 2013], however, signs of infection already took the smile off his face; 5 days later, the KPC-producing bacteria took his life. A day earlier, on [18 Jun 2013], a 49-year-old patient, who had received the other kidney, died at Hospital Fundao (UFRJ - Federal University of Rio de Janeiro). Another patient who had received the liver from the same donor at Adventist Hospital Silvestre in Cosme Velho 7 days earlier, on [12 Jun 2013], also died.

The medical director of Adventist Hospital Silvestre, Rogerio Gusmao, said of the patient who died after liver transplantation that he regretted the incident. According to him, the liver received by staff surgeon Eduardo Fernandes arrived with a report that it was in perfect condition serologically and functionally. Gusmao also said that during the whole process all international protocols were followed in full.

Doctors who specialize in transplants, who prefer not to be named, explained that the team that makes the organ procurement has an obligation to review the medical records of the donor, check for infection and communicate it to teams that do the transplantation. With this information, transplanters decide whether to accept the organ. "There is no time to culture organs that come to us. We have to trust the data sent by harvesting team," explained one of the doctors.

In the case of the kidney, the organ is transported within 3 sterile bags, one inside the other, and kept in the so-called perfusion fluid, which improves their condition for transplantation. The kidney is only removed from the bag when it is implanted in the patient. Thus, the examination that showed KPC-producing acteria in the perfusion fluid indicates that the donated organs brought the germ that took the lives of 3 transplant patients.

[However,] "the microbiological screening done in the [donor] patient was negative, i.e., the patient had no clinical septic [sepsis] hindering organ donation." Although the report signed by the surgeon who harvested the organs noted purulence [presence of pus] in the abdominal cavity, the organs taken from the [donor] patient were noted to be anatomically fit for transplantation.