Health Care-Associated Infection in Solid Organ Transplant Recipients.

BACKGROUND: Health care-associated infection (HAI) represent a global health problem with an increase in hospital stays, deaths, and monetary costs. Recipients of solid organ transplants are a population at risk. The objectives of the study were to characterize the incidence of HAI in renal and hepatic transplant recipients as well as to compare them with the population without transplants in intensive care units (ICU). METHODS: The data on the incidence of HAI, localization, microorganisms, and demographics were taken from the patients admitted between the years 2013 to 2018 (n = 4307) from the registration of the Project for the Reduction of Nosocomial Infection in Intensive Care Units. The variables were compared with those of renal transplant (n = 96) and liver transplants (n = 68) recipients. RESULTS: Renal transplant recipients showed 26% incidence of HAI. The most frequent were surgical site infection (SSI), urinary tract infection, and primary bacteremia; the most frequent microorganism was Staphylococcus spp, mortality 3.8%. Liver transplant recipients showed 41% incidence of HAI. The most frequent were tracheobronchitis associated with mechanical ventilation, SSI, and primary bacteremia; the most frequent microorganism was Staphylococcus spp, mortality 37%. The population without transplants in the ICU showed 17% incidence of HAI. The most frequent were respiratory infections associated with mechanical ventilation, primary bacteremia, and SSI; the most frequent microorganism was Acinetobacter spp, mortality 21%. CONCLUSIONS: HAI in recipients of solid organ transplants (renal and hepatic) have a higher incidence than in a population without transplants. The location and causal microorganisms have particularities that must be taken into account for the development of prevention protocols.

Post-traumatic growth and its relationship to quality of life up to 9 years after liver transplantation: a cross-sectional study in Spain.

OBJECTIVE: Little is known concerning post-traumatic growth (PTG) after liver transplantation. Against this backdrop the current study analysed the relationship between PTG and time since transplantation on quality of life. Furthermore, it compared PTG between liver transplant recipients and their caregivers. DESIGN: Cross-sectional case-control study. SETTING: University Hospital in Spain. PARTICIPANTS: 240 adult liver transplant recipients who had undergone only one transplantation, with no severe mental disease, were the participants of the study. Specific additional analyses were conducted on the subset of 216 participants for whom caregiver data were available. Moreover, results were compared with a previously recruited general population sample. OUTCOME MEASURES: All participants completed the Posttraumatic Growth Inventory, and recipients also filled in the 12-Item Short-Form Health Survey. Relevant sociodemographic and clinical parameters were also assessed. RESULTS: In the sample of 240 recipients, longer time since transplantation (>9 years) was associated with more pain symptoms (p=0.026). Regardless of duration, recipients showed lower scores on most quality of life dimensions than the general population. However, high PTG was associated with a significantly higher score on the vitality quality of life dimension (p=0.021). In recipients with high PTG, specific quality of life dimensions, such as bodily pain (p=0.307), vitality (p=0.890) and mental health (p=0.353), even equalled scores in the general population, whereas scores on general health surpassed them (p=0.006). Furthermore, liver transplant recipients (n=216) compared with their caregivers showed higher total PTG (p<0.001) and higher scores on the subscales relating to others (p<0.001), new possibilities (p<0.001) and appreciation of life (p<0.001). CONCLUSIONS: Our findings highlight the protective role of PTG in the long-term outcome of liver transplant recipients. Future studies should analyse and develop psychosocial interventions to strengthen PTG in transplant recipients and their caregivers.

Coping Strategies in Liver Transplant Recipients and Caregivers According to Patient Posttraumatic Growth.

The purpose of this study was to analyze the differences in coping strategies employed by liver transplant recipients and their family members according to patient posttraumatic growth. Two matched groups of 214 liver transplant recipients and 214 family members were selected. The Posttraumatic Growth Inventory and Brief COPE were used. The most relevant results were: (1) Interactive effects in active coping, support (instrumental and emotional) and acceptance strategies, which were all used more by patients with higher growth levels, while their family members showed no differences in use of these strategies by patient growth level. Furthermore, while a low level of patient growth did not mark differences between them and their caregivers, a high level did, patients employing more active coping and support (instrumental and emotional), (2) In both groups a high level of patient growth was associated with more use of positive reframing and denial than a low one, and (3) Self-blame was employed by patients more than by their caregivers. It was concluded that a high level of posttraumatic growth in liver transplant recipients is associated with more use of healthy coping strategies, basically active coping, instrumental support, and emotional support.

Psychological differences of patients and relatives according to post-transplantation anxiety.

The aim of this investigation is to analyze the psychological differences of patients and their relatives according to the formers' post-transplantation anxiety. We used two groups of participants: transplant patients (n = 166) and close relatives (n = 166). Four questionnaires were applied: a Psychological Survey (to both groups), the Hospital Anxiety and Depression Scale, and the Quality of Life Questionnaire (to the transplant patients), and the Leeds Scales for the Self-Assessment of Anxiety and Depression (to the relatives). Participants were assessed twice: post-Intensive Care Unit (ICU; when patients were moved from the ICU to the Transplantation Unit) and post-hospital (one year after transplant). Results showed that high anxiety in patients just after organ transplant was related to an increase of anxiety and depression symptoms both in patients and relatives one year after transplant; it was also related to a decrease in the quality of life of these patients.

Psychological Differences of Patients and Relatives according to Post-Transplantation Anxiety

The aim of this investigation is to analyze the psychological differences of patients and their relatives according to the formers’ post-transplantation anxiety. We used two groups of participants: transplant patients (n = 166) and close relatives (n = 166). Four questionnaires were applied: a Psychological Survey (to both groups), the Hospital Anxiety and Depression Scale, and the Quality of Life Questionnaire (to the transplant patients), and the Leeds Scales for the Self-Assessment of Anxiety and Depression (to the relatives). Participants were assessed twice: post-Intensive Care Unit (ICU; when patients were moved from the ICU to the Transplantation Unit) and post-hospital (one year after transplant). Results showed that high anxiety in patients just after organ transplant was related to an increase of anxiety and depression symptoms both in patients and relatives one year after transplant; it was also related to a decrease in the quality of life of these patients (AU)

El objetivo de esta investigación es analizar las diferencias psicológicas en pacientes y familiares en función de la ansiedad post-trasplante. Seleccionamos dos grupos: 166 trasplantados y los 166 familiares más allegados de estos pacientes. Empleamos una Encuesta Psicosocial (en ambos grupos), la Escala de Ansiedad y Depresión en Hospital y el Cuestionario de Calidad de Vida (en el grupo de trasplantados) y las Escalas de Ansiedad y Depresión de Leeds (en el grupo de familiares). La evaluación psicológica se realizó en dos fases: post-UCI (cuando a los pacientes se les daba el alta de la UCI pero continuaban ingresados en el hospital, concretamente, en la Unidad de Trasplantes) y post-hospitalaria (cuando transcurría un año del alta hospitalaria de los pacientes tras el implante). Los resultados mostraron que un nivel alto de ansiedad en los pacientes tras el trasplante, aumentaba al año la sintomatología ansiosa y depresiva de los pacientes y de sus familiares y, además, empeoraba la calidad de vida de los trasplantados (AU)

Salud mental de los familiares de los transplantados / Mental health in relatives of transplant patients

El objetivo de esta investigación es analizar la influencia del lugar de hospitalización (Unidad de Cuidados Intensivos o Unidad de Trasplantes), la salud mental (sintomatología ansiosa y depresiva) y la duración de la estancia hospitalaria (poco o mucho tiempo de hospitalización) de los trasplantados en la sintomatología ansiosa y depresiva de sus familiares más allegados. Seleccionamos dos grupos: 166 trasplantados y los 148 familiares más allegados de estos pacientes. Empleamos una «Encuesta Psicosocial» (en ambos grupos), la «Escala de Ansiedad y Depresión en Hospital» (en el grupo de trasplantados) y las «Escalas de Ansiedad y Depresión de Leeds» (en el grupo de familiares). Los resultados mostraron que los familiares presentaban más sintomatología ansiosa y depresiva cuando sus allegados trasplantados estaban ingresados en la Unidad de Cuidados Intensivos, tenían puntuaciones altas en ansiedad y depresión en la Unidad de Trasplantes y permanecían hospitalizados durante mucho tiempo en dicha Unidad

The aim of this investigation is to analyse the influence of the place of hospitalization (Intensive Care Unit or Transplant Unit), the mental health (anxiety and depression symptoms) and the duration of stay in hospital (little or a long time) of transplant patients on symptoms of anxiety and depression exhibited by close relatives of transplant patients. The subject groups were made up of 166 transplant patients and 148 close relatives. The tests applied were a «Psychological Questionnaire» (both groups), «The Hospital Anxiety and Depression Scale» (transplant patients) and «The Leeds Scales for the Self-Assessment of Anxiety and Depression» (relatives). The results showed that relatives exhibited more symptoms of anxiety and depression: when the transplant patients were admitted to the Intensive Care Unit, they showed high scores of anxiety and depression in the Transplant Unit and were in this unit for a long period