Becker's Clinical Quality & Infection Control

12 INFECTION CONTROL How 9 hospitals are approaching COVID-19 vaccines for transplant patients By Erica Carbajal M any of the country's more than 250 organ transplant centers now re- quire COVID-19 vaccination for both organ recipients and donors, Kaiser Health News reported Oct. 8. Aurora, Colo.-based UCHealth garnered attention in October for its policy that it will not perform organ transplants on unvaccinated patients in nearly all situations, but the health system is not alone. Other large systems — including Cleveland Clinic and University Hospitals, also based in Cleveland — have adopted similar policies, NBC News reported. UW Medicine in Seattle has done the same, according to Kaiser Health News. Transplant programs implementing these policies note the requirement is akin to other conditions transplant recipients must abide by, such as those requiring people quit smoking or using drugs before a transplant. ey also pointed to studies indicating transplant recipients are at higher risk of severe COVID-19 illness and outcomes. "Patients who have received a transplanted organ are at significant risk from COVID-19," Dan Weaver, a spokesperson for UCHealth, said in an email to Becker's. "Should they become infected, they are at particularly high risk of severe illness, hospitalization and death. Studies have found transplant patients who contract COVID-19 may have a mortality rate of 20 percent or higher. A living donor could pass COVID-19 infection on to an organ recipient even if they initially test negative for the disease, putting the patient's life at risk." Other systems have opted to move unvaccinated patients lower down on their transplant lists, while some have no policy at all. "We do not have a policy regarding COVID-19 vaccination requirement for transplant candidates," a spokesperson for the University of Pittsburgh Medi- cal Center told the Tribune-Review. "UPMC continues its vaccine advocacy and outreach efforts and makes vac- cines easily and readily available for all." Other hospitals currently not requiring the vaccine for organ transplants include Houston Methodist, Dallas-based Baylor University Medical Center, Northwest- ern Medicine in Chicago and Tampa (Fla.) General Hospital, Kaiser reported. e United Network for Organ Sharing, the national network that coordinates the country's organ donations, gives transplant centers the discretion over spe- cific requirements for removing or adding candidates to transplant wait lists. However, Kapilkumar Patel, MD, director of the lung transplant program at Tampa General Hospital, expects COVID-19 vaccination will eventually become mandatory at nearly all transplant centers in the U.S., since they are evaluated on the longer-term survival of their patients. "I think it's going to spread like wildfire across the country," Dr. Patel told Kaiser Health News. "If you start losing [transplant] patients in a year due to COVID-19, it will be mandated sooner rather than later." n Older Americans die disproportionately from antibiotic-resistant infections, study shows By Katie Adams A mericans ages 65 and older are dis- proportionately affected by infections resistant to antibiotic treatment, ac- cording to a study published Oct. 7 in Clinical Infectious DIseases. The study — conducted by The Pew Charitable Trusts, the Infectious Diseases Society of Amer- ica and the University of Utah in Salt Lake City — used data from the Veterans Health Adminis- tration on patients admitted between January 2007 and December 2018 to estimate how many deaths resulted from infections caused by six common antibiotic-resistant pathogens. The researchers generalized their findings to the Americans who are ages 65 and older, producing estimates for 2017 by multiplying pathogen-specific estimates by national case counts from hospitalized patients. The researchers found that of the estimated 30,000 deaths resulting from antibiotic-resis- tant infection in 2017, people ages 65 and older accounted for 12,000 of those deaths. This means older Americans made up about 40 percent of deaths from antibiotic-resistant infections in 2017, even though this age group accounted for only 15 percent of the U.S. pop- ulation that year. The study also found that antibiotic-resistant infections in older Americans resulted in nearly $1.9 billion in healthcare costs in 2017. The researchers said older Americans could be more susceptible to antibiotic-resistant infec- tions because of age-related decline in the abil- ity to fight disease, higher likelihood of multiple chronic conditions and living in long-term care facilities where infections spread easily. In its analysis of the study, The Pew Charitable Trusts said Congress and federal agencies such as CMS "need to prioritize actions and invest- ments that will strengthen the existing arsenal against antibiotic-resistant infections by spur- ring the development of new antibiotics and slowing the emergence of these infections by reducing inappropriate antibiotic use, which is a primary driver of antibiotic resistance in hospi- tals, nursing homes and the community." n

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