Organs from a 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

BACKGROUND: In 2015, an outbreak of invasive Streptococcus agalactiae serotype III, multilocus sequence type (MLST) 283, related to raw freshwater fish consumption was reported in Singapore. Clinical manifestations of this strain of S. agalactiae were associated with severe clinical course, septicemia and higher incidence of neurological infection. Reports of successful solid organ transplantation from donors with infective endocarditis (IE) are uncommon. METHODS: We present a patient who received kidney transplantation from a donor with S. agalactiae IE. RESULTS: A 59-year-old man had disseminated S. agalactiae infection causing IE, endopthalmitis, septic arthritis of the right knee, and lumbar spondylodiscitis. Blood cultures, synovial fluid on admission grew S. agalactiae serotype III MLST 283. A transthoracic echocardiogram showed an aortic valve vegetation measuring 0.8 × 0.3 cm. He demised from an intracranial bleed 12 days after admission. Blood cultures prior to harvest, urine cultures and pre-implantation biopsies did not demonstrate infection. Our recipient is a 65-year-old woman with end-stage renal failure. She underwent dual deceased donor kidney transplantation. She received IV basiliximab, IV methylprednisolone followed by PO prednisolone, MMF, and tacrolimus. There was no delayed graft function. She was treated for pneumonia post-operatively and received IV Meropenem and later IV piperacillin–tazobactam for 7 days and subsequently IV ceftriaxone for 2 weeks. She remains well without evidence of S. agalactiae transmission 6 months later. On follow-up, urine cultures are negative with good graft function. CONCLUSION: This strain of bacteria is associated with invasive infection suggesting increased virulence, the experience from the 2015 outbreak in Singapore echoes this finding. To our knowledge, this is the first reported renal transplantation from a donor with a zoonotic S. agalactiae IE. Whilst IE is not an absolute contraindication to organ transplantation, caution should taken with administration of appropriate antibiotics to donor and recipient. This supports guidelines of a less-restrictive donor screening criteria and potentially increases the donor pool. DISCLOSURES: All authors: No reported disclosures.