Changing trends in the aetiology, treatment and outcomes of bloodstream infection occurring in the first year after solid organ transplantation: a single-centre prospective cohort study

Abstract

To analyse trends in the aetiology, treatment and outcomes of bloodstream infection (BSI) within the first year post-transplant over the last 10-year period, we prospectively recorded all episodes of BSI occurring in solid organ transplant (SOT) recipients during the first year post-transplant from 2007 to 2016. Trends of factors were analysed by 2-year periods. Of 475 consecutive episodes of BSI, 218 occurred within a year of SOT in 178 SOT recipients. Gram-positive BSI decreased over time (40.5-2.2%). In contrast, there was a steady increase in Gram-negative bacilli (GNB) BSI (54.1-93.3%; P < 0.001), mainly due to Pseudomonas aeruginosa (2.4-20.4%) and Klebsiella pneumoniae (7.1-26.5%). Multidrug-resistant (MDR) GNB (4.8-38.8%; P < 0.001) rose dramatically, especially due to extended-spectrum β-lactamase (ESBL) production (7.1-34.7%). There was a sharp rise in the use of carbapenems, both as empirical (11.9-55.3%; P < 0.001) and as targeted antibiotic treatment (11.9-46.9%; P < 0.001). In conclusion, today, GNB are the leading causative agents of BSI in SOT recipients within the first year after SOT. In addition, MDR GNB have emerged mainly due to ESBL-producing strains. In spite of these changes, length of hospital stay, days of treatment and mortality have remained stable over time.

Study on the Differentially Expressed Genes and Signaling Pathways in Systemic Lupus Erythematosus Using Integrated Bioinformatics Method

“…GNB2 is a house-keeping gene that codes for RACK1 protein in normal cells [34] . RACK1 protein as an important protein skeleton, intracellular protein joint, anchored proteins, involved in compound generated signaling molecule in cells, affect the active molecule subcellular localization, communication and the connection between the different signaling pathways, so as to exert its for signal transduction, gene expression, cell proliferation, differentiation and so on various aspects of adjustment, so the researchers widely believe that GNB2 participated in many important physiological processes and organisms as an important role in it [35][36] . When cells are stimulated, genes can respond quickly, encode synthetic proteins, realize transcriptional regulation and post-transcriptional level regulation of genes, and further trigger a series of delayed responses [37] .…”

Challenges in the Diagnosis and Management of Bacterial Lung Infections in Solid Organ Recipients: A Narrative Review

“…Bacterial infections have always been a leading cause of morbidity and mortality among SOTRs, threatening the success of transplantation [2]. In the last decades, the severity of bacterial infections in SOTRs increased due to the emergence of MDR Gram-negative organisms, defined as bacteria non-susceptible to ≥1 agent in three or more antimicrobial categories [48][49][50][51]. Frequent antibiotic exposure, microbiome alterations, recurrent hospitalizations, and hepatic failure are major risk factors associated with MDR Gram-negative infections in the pretransplant period.…”

Multidrug-Resistant Organisms: Posttransplant Management for Extended-Spectrum Beta-Lactamase Producers and Carbapenem-Resistant Enterobacterales

“…In SOT recipients, the proportion of Enterobacterales that harbor ESBL enzymes in clinical blood samples fluctuates by region and local resistance patterns, ranging from 3% in the USA (although this estimate is from 2007) to 60% in China [5,[10][11][12][13]. Similarly, the risk of developing an ESBL-EB infection posttransplant varies by geography but ranges between 3.4 and 16.9% in abdominal organ transplant recipients (Table 1) [14][15][16][17][18][19][20][21].…”

“…Klebsiella pneumoniae and Escherichia coli are the most common ESBL-EB identified in SOT recipients [5,[14][15][16][17]21]. Regional differences, however, do exist.…”

“…The incidence of multidrug-resistant Gram-negative bacterial infections, in particular those due to extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (ESBL-EB) and carbapenem-resistant Enterobacterales (CRE), has been increasing worldwide [1][2][3][4][5]. This is of particular concern to immunocompromised patients, including solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients [6][7][8], although risk factors vary based on geographical location and organ transplanted.…”