Status:
Ready to upload
Record number:
2025
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
The estimated frequency of contamination of preservation fluid by Streptococcus species in solid organ transplantation is very low and not as well characterized as for fungal organisms like Candida spp. While precise numbers are scarce, Streptococcus spp. are considered rare contaminants of preservation fluid, and most available data are limited to isolated case reports or small series.
Time to detection:
The donor had been diagnosed with a Streptococcus agalactiae endocarditis that was correctly treated. Blood cultures on day +4 and +12 were negative for S. agalactiae as were urine cultures. Similarly, all cultures from the recipient remained negative for S. agalactiae throughout the course of follow-up.
Alerting signals, symptoms, evidence of occurrence:
There was no evidence of donor-derived infection. In fact, it appears that the recipient was administered antibiotics not as prophylaxis but for the treatment of pneumonia that developed two days after transplantation. Conversely, this case highlights the potential for using organs from donors with endocarditis in whom the bacteremia is well controlled.
Demonstration of imputability or root cause:
Not applicable
Groups audience:
Keywords:
Reference attachment:
Suggest references:
A Case Report: Organs From a Donor With Highly Virulent Zoonotic Outbreak Strain of Streptococcus agalactiae Serotype III, Multilocus Sequence Type 283 Infective Endocarditis Did Not Result in Transmission With Adequate Prophylactic Antibiotic Cover. Sim J, et al. Transplant Proc. 2017 Sep;49(7):1587-1590
Note:
I believe this case cannot be properly classified as a donor-derived infection due to the fact that the infection in the donor was microbiologically cleared (evidenced by negative blood cultures) 8 days before procurement.
Expert comments for publication:
Donors with active infection that are appropriately treated are not necessarily contraindicated for transplantation-specially when directed antibiotic treatment is continued in the recipient. In such cases, even highly virulent microorganisms may pose minimal risk if effective treatment is initiated in the donor and the infection is well controlled. Targeted antibiotic therapy in the donor and prophylaxis in the recipient is currently considered a key factor in preventing transmission.
This case supports the adoption of no restrictive criteria for donor selection when infections are properly managed, potentially expanding the donor pool. Specifically, It highlights that infective endocarditis is not necessarily a contraindication to organ donation if managed carefully. It also emphasizes the importance of individualized risk-benefit assessment, rigorous screening, and close recipient monitoring when using organs from infected donors.