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The significance of positive cultures of organ preservation fluid (OPF) in solid organ transplantation is not known. We sought to describe the microbiology and define the clinical impact of positive OPF cultures.
Retrospective cohort study.
Tertiary care hospital.
A consecutive sample of all solid organ transplantations at our center between July 2006 and January 2009 was reviewed. A total of 331 allografts (185 kidneys, 104 livers, 31 pancreases, and 11 hearts) met the inclusion criterion of having OPF cultures taken from the transplanted allograft.
Organisms recovered from OPF were classified as high or low risk according to their virulence. Clinical outcomes were compared between recipients of organs with positive OPF cultures and recipients of organs with negative OPF cultures.
OPF cultures were positive in 62.2% of allografts and yielded high-risk organisms in 17.8%. Normal skin flora constituted the majority of positive OPF cultures, while Enterobacteriaceae spp. and Staphylococcus aureus made up the majority of high-risk organisms. Recipients of allografts with positive OPF cultures developed more frequent bacterial infections, regardless of allograft type (relative risk, 2.39; 95% confidence interval [CI], 1.61–3.54). Moreover, isolation of a given organism in OPF samples was associated with the development of a clinical infection with the same organism, regardless of allograft type.
Positive cultures of OPF are common events in solid organ transplantation, frequently involve high-risk organisms, and are associated with the development of postoperative clinical bacterial infections. Further study is required to determine the optimal strategies for their prevention and management.
Most accounts of coral bleaching rarely take the story further than an initial report of the event, yet it has become clear that longer-term effects may occur at several scales: those of the corals themselves, of the wider ecological community which is based upon the corals and the three-dimensional reef structure they create, and of the human communities which depend on the coral ecosystem for food, wave protection or tourism-related revenues. Several factors change profoundly in areas where mass mortality follows coral bleaching, as was particularly evident following the severe warming event of 1998. During this period, substantial proportions of corals were killed on reefs throughout the tropics, but most particularly in the Indian Ocean where mortality was commonly 50–100% in shallow water. This chapter describes and predicts some of the consequences of changes induced by coral mortality.
First, I clarify two definitions. The distinction is emphasized between coral bleaching and coral mortality. These two terms are commonly conflated, perhaps because they have a clear relationship (McClanahan, 2004). In this chapter, bleaching (perhaps obviously) refers to the blanched appearance of corals following zooxanthellae expulsion. This state may last from days to several months, and a bleached coral may recover, or it may die. Where recovery occurs, the bleaching story usually ends simply – indeed it may never really have started other than at the coral's own physiological level. When bleached corals die in large numbers, however, as seen in 1998, changes become considerable at all scales.