Colonization and Infection With Extensively Drug Resistant Gram-Negative Bacteria in Liver Transplant Recipients

Background: Multi-drug resistant organisms (MDRO) are an emerging health problem with an important impact on clinical outcome in Intensive Care Units (ICUs) and immunocompromised patients. Conversely, the role of MDRO colonization in Internal Medicine is less clear. The objective of our study is to evaluate the clinical impact (namely sepsis development, in-hospital and 30-days mortality, and re-hospitalization) of MDRO colonization in Internal Medicine. Methods: Patients admitted to our Internal Medicine Unit between January 2019 and March 2020 were potentially includible. Outcomes in patients with a positive rectal swab for MDRO (RS+) and in patients without a RS+ were compared. Results of the multivariate analyses were expressed as Odds Ratios (ORs) and the corresponding 95% Confidence Interval (CI). Results: In a cohort of 2147 patients, 77 patients with RS+ were consecutively identified; 377 patients with a rectal swab negative for MDRO were randomly selected from the same cohort (five for each patient with RS+). At the multivariate analysis, RS+ was associated with an increased risk of sepsis development during hospitalization (OR 4.18; 95% CI, 1.99–8.78) and with death or re-hospitalization at 30 days (OR 4.79; 95% CI, 2.79–8.23), whereas RS+ did not appear to be associated with death during hospitalization or need for ICU transfer. Conclusions: Our results suggest for the first time a prognostic role for RS+ in Internal Medicine. Thus, assessment of rectal swab at hospital admission appears useful even in this setting. However, larger prospective studies and a cost–benefit analysis are needed to confirm our preliminary findings.

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“…Similar results in non-ICUs settings were reported in patients receiving a transplant, in hematological and in cirrhotic patients [ 9 , 10 ].…”

Section: Discussionsupporting

confidence: 85%

“…It is well known that in Intensive Care Units (ICU) and in high-risk patients (i.e., onco-hematological patients and in solid-organ transplant recipients), MDRO colonization is associated with an increased risk of infection and adverse outcomes [ 8 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Implications of Multi-Drug Resistant Organisms’ Gastrointestinal Colonization in an Internal Medicine Ward: The Pandora’s Box

Para

Caruso

Blasi

et al. 2022

JCM

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“…In this regard, the correlation between MDRO colonization and MDRO-associated infection must be addressed. Especially in patients with MDRGN positivity, the progression risk from colonization to infection has been well described [12,13,[30][31][32]. Since LT is a curative approach in cirrhotic patients, we assume that this also translates into a lesser impact of MDRO-associated lethal complications.…”

Section: Discussionmentioning

confidence: 98%

Colonization with multidrug-resistant organisms is associated with in increased mortality in liver transplant candidates

et al. 2021

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Objectives Rising prevalence of multidrug-resistant organisms (MDRO) is a major health problem in patients with liver cirrhosis. The impact of MDRO colonization in liver transplantation (LT) candidates and recipients on mortality has not been determined in detail. Methods Patients consecutively evaluated and listed for LT in a tertiary German liver transplant center from 2008 to 2018 underwent screening for MDRO colonization including methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant gram-negative bacteria (MDRGN), and vancomycin-resistant enterococci (VRE). MDRO colonization and infection status were obtained at LT evaluation, planned and unplanned hospitalization, three months upon graft allocation, or at last follow-up on the waiting list. Results In total, 351 patients were listed for LT, of whom 164 (47%) underwent LT after a median of 249 (range 0–1662) days. Incidence of MDRO colonization increased during waiting time for LT, and MRDO colonization was associated with increased mortality on the waiting list (HR = 2.57, p<0.0001. One patients was colonized with a carbapenem-resistant strain at listing, 9 patients acquired carbapenem-resistant gram-negative bacteria (CRGN) on the waiting list, and 4 more after LT. In total, 10 of these 14 patients died. Conclusions Colonization with MDRO is associated with increased mortality on the waiting list, but not in short-term follow-up after LT. Moreover, colonization with CRGN seems associated with high mortality in liver transplant candidates and recipients.

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“…Yeşilkaya et al found that the XDR rate for A. baumannii was 38.9% [16]. Therefore, it is important to know the patient's colonization status in order to provide appropriate empirical antibiotic treatment rather than beginning inappropriate broad-spectrum antibiotics [17,18].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of extensively drug-resistant gram-negative bacteremia among solid-organ transplant recipients: a multicenter study

et al. 2021

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Background/aim: The aim of this study is to evaluate the distribution, sources, clinical features, and mortality rates of bacteremia due to evaluation of extensively drug-resistant (XDR) gram negative among solid-organ transplant (SOT) recipients. Materials and methods:A retrospective study of SOT recipients with bacteremia due to XDR gram-negative pathogens in 11 centers between 2016 and 2018 was conducted. Patients' records were evaluated.Results: Of 171 bacteremia that occurred in 164 SOT recipients, 93 (56.7%) were liver, 46 (28%) kidney, 14 (8.5%) heart, and 11 (6.7%) lung recipients. Bacteremia episodes were recorded in the first year in 63.7% of the patients (n = 109), early-onset bacteremia was recorded in 45% (n = 77) of the episodes. In multivariate analysis, catheter-associated bacteremia was an independent risk factor for 7-day mortality (p = 0.037), and early-onset bacteremia was found as an independent risk factor for 30-day mortality (p = 0.017). Conclusion:Difficult-to-treat infections due to XDR bacteria in SOT recipients shadow the success of transplantation. Central venous catheters seem to be the main risk factor. Judicious use of medical devices is of pivotal importance.

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Colonization and Infection With Extensively Drug Resistant Gram-Negative Bacteria in Liver Transplant Recipients

Cited by 16 publications

References 9 publications

Clinical Implications of Multi-Drug Resistant Organisms’ Gastrointestinal Colonization in an Internal Medicine Ward: The Pandora’s Box

Clinical Implications of Multi-Drug Resistant Organisms’ Gastrointestinal Colonization in an Internal Medicine Ward: The Pandora’s Box

Colonization with multidrug-resistant organisms is associated with in increased mortality in liver transplant candidates

Evaluation of extensively drug-resistant gram-negative bacteremia among solid-organ transplant recipients: a multicenter study

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