Transplant recipients are at high risk for infections. However, donor-recipient transmission of multidrug-resistant organisms (MDROs) remains mostly unaddressed in the protocols of pre-transplant infection and colonization screening. Vancomycin-resistant enterococci (VRE) are MDROs that colonize the gastrointestinal tract and are associated with a significant burden of disease. Besides the high mortality of invasive VRE infections, chronic colonization leads to costly isolation measures in the hospital setting. Whereas most post-transplantation VRE infections are endogenous and thus preceded by colonization of the recipient, conclusive evidence of VRE transmission via allograft in the context of intestinal transplantation is lacking. We describe a donor-derived VRE infection after intestinal transplantation including small bowel and right hemicolon. The recipient, a 54-year old male with history of mesenteric ischemia and small bowel perforation due to generalized atherosclerosis and chronic stenosis of the celiac trunk and the superior mesenteric artery, developed an intra-abdominal infection and bloodstream infection after transplantation. VRE isolates recovered from the patient as well as from the allograft prior to transplantation were analyzed via whole genome sequencing. Isolates showed to be genetically identical, thus confirming the transmission from donor to recipient. This case underlines the relevance of donor-recipient VRE transmission and invasive infection in the context of intestinal transplantation, highlighting the need for preoperative MDRO screening that facilitates the prompt and effective treatment of possible infections as well as the timely establishment of contact precautions to prevent further spread.

中文翻译：

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肠道移植后供体来源的耐万古霉素肠球菌传播和血流感染

移植受者感染的风险很高。然而，在移植前感染和定植筛查的方案中，多药耐药生物体 (MDRO) 的供体-受体传播仍未得到解决。耐万古霉素肠球菌 (VRE) 是定植胃肠道并与重大疾病负担相关的 MDRO。除了侵入性 VRE 感染的高死亡率外，慢性定植导致在医院环境中采取昂贵的隔离措施。尽管大多数移植后 VRE 感染是内源性的，因此先于受者定植，但缺乏在肠移植背景下通过同种异体移植物传播 VRE 的确凿证据。我们描述了包括小肠和右半结肠在内的肠道移植后供体来源的 VRE 感染。受者，一名 54 岁男性，因全身动脉粥样硬化和腹腔干和肠系膜上动脉慢性狭窄导致肠系膜缺血和小肠穿孔病史，移植后发生腹腔内感染和血流感染。通过全基因组测序分析从患者以及移植前的同种异体移植物中回收的 VRE 分离物。分离株显示出基因相同，从而证实了从捐赠者到接受者的传播。该病例强调了肠道移植背景下供体-受体 VRE 传播和侵入性感染的相关性，