Staphylococcus aureus

DONOR: a male with history of non-medical injection drug use with methicillin-resistant S. aureus (MRSA) endocarditis (positive blood cultures+autopsy) who died of intracerebral hemorhage due to septic emboli; declared brain dead within 24 hours from admission. Received 2 doses of vancomycin and blood cultures obtained 3 days before organ recovery were negative. LUNG RECIPIENT: No history of MRSA colonization (nasal swab 7 days before transplantation negative). Intraoperative routine lung biopsy positive for MRSA. Vancomycin initiated at the time of transplantation. Surveillance blood cultures collected on day 6 after transplantation were positive for MRSA.MRSA growth observed in 4 surveillance BAL cultures during the subsequent 6 weeks, with no signs or symptoms of infection. He completed 9 weeks of antibiotic therapy. BAL negative on POD+ 99. Six months after transplant he presented with MRSA pneumonia (BAL culture positive for MRSA) cured with 4 weeks of vancomycin . PANCREAS AND LEFT KIDNEY RECIPIENT: Surveillance blood cultures negative. Five doses of vancomycin prophylaxis without transmission. LIVER: Blood cultures positive 3 hrs after transplantation. He received daptomycin at the time of transplantation, continued for 14 days. Re-admitted on POD+58 with MRSA bacteremia, treated with a 6- week course of vancomycin and cured. RIGHT KIDNEY RECIPIENT: Surveillance blood cultures negative. Five doses of vancomycin prophylaxis without transmission.