Transplant & Oncology ID: Literature Dives

This research article reports on a randomized clinical trial (BEATLE) investigating the efficacy of extended-infusion versus intermittent-infusion β-lactam antibiotics in treating febrile neutropenia in hematological patients. The study, conducted across four Spanish hospitals, aimed to determine if extended infusion improved treatment success, defined as defervescence without antibiotic changes. Results showed no significant difference in treatment success between the two groups. However, extended infusion achieved higher pharmacokinetic/pharmacodynamic targets for susceptible Pseudomonas aeruginosa. The authors conclude that extended infusion isn't routinely warranted but may benefit patients with infections caused by less susceptible microorganisms. Created with NotebookLM by Google so there may be mistakes and/or errors. PMID: 39433124 Laporte-Amargos J, Carmona-Torre F, Huguet M, et al. Efficacy of extended infusion of β-lactam antibiotics for the treatment of febrile neutropenia in haematologic patients (BEATLE): a randomized, multicentre, open-label, superiority clinical trial. Clin Microbiol Infect 2024;S1198-743X(24)00488-9.

This research article from Nature Medicine examines the lung microbiome and its connection to mortality in pediatric patients post-hematopoietic cell transplantation (HCT). The study identified four distinct lung microenvironment clusters based on microbiome composition and gene expression, revealing that depletion of beneficial bacteria coupled with viral or fungal enrichment strongly predicted in-hospital death. Antibiotic use significantly contributed to this dysbiosis. The findings were validated in an independent cohort, suggesting potential for improved diagnostics and treatments targeting specific lung microenvironment profiles. The researchers propose that precision pulmonary phenotyping could improve HCT outcomes. Created with NotebookLM by Google so there may be mistakes and/or errors. PMID: 38783139Zinter MS, Dvorak CC, Mayday MY, et al. Pathobiological signatures of dysbiotic lung injury in pediatric patients undergoing stem cell transplantation. Nat Med 2024;30(7):1982–93.

This multicenter study investigated the clinical utility of plasma microbial cell-free DNA (mcfDNA) sequencing as an adjunctive diagnostic tool for pneumonia in immunocompromised patients. Researchers compared the diagnostic yield of mcfDNA sequencing to standard clinical testing in a prospective observational trial. The results demonstrated that mcfDNA sequencing significantly increased the detection of pneumonia etiologies, particularly in cases where conventional methods failed. This non-invasive approach offers a potential improvement in the diagnosis and treatment of pneumonia in this vulnerable population. The study also noted some limitations, including incomplete standard testing in a subset of patients and the impact of prior antimicrobial therapy. Created with NotebookLM by Google so there may be mistakes and/or errors. PMID: 37815489 Bergin SP, Chemaly RF, Dadwal SS, et al. Plasma Microbial Cell-Free DNA Sequencing in Immunocompromised Patients With Pneumonia: A Prospective Observational Study. Clin Infect Dis 2024;78(3):775–84.

We review the findings of the HOPE in Action study published in the New England Journal of Medicine (Durand et al., 2024). The study addresses the safety and efficacy of transplanting kidneys from deceased donors with HIV to recipients with HIV, a practice made legal for research in the U.S. following the 2013 HIV Organ Policy Equity (HOPE) Act. Created with NotebookLM by Google so there may be mistakes and/or errors. PMID: 39413376 Durand CM, Massie A, Florman S, et al. Safety of Kidney Transplantation from Donors with HIV. N Engl J Med 2024;391(15):1390–401.