Colonization with extended‐spectrum beta‐lactamase‐producing <scp>E</scp>nterobacteriaceae in solid organ transplantation: A meta‐analysis and review

Alevizakos, Michail; Kallias, Athanasios; Flokas, Myrto Eleni; Mylonakis, Eleftherios

doi:10.1111/tid.12718

Cited by 21 publications

(18 citation statements)

References 37 publications

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“…Over the last decade, Gram-negative bacteria have become the focus of attention regarding antibiotic resistance for both the general hospital population and SOT-recipients. A recent systematic review reported that 20% of SOT-recipients are colonized with ESBL-producing Escherichia coli [ 3 ]. Colonization by ESBL-producing isolates is an important risk factor for subsequent infection [ 4 ]; about one in 10 renal transplant recipients (RTR) colonized by ESBL-producing bacteria experiences a urinary tract infection (UTI) caused by these pathogens [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Temporal trends, risk factors and outcomes of infections due to extended-spectrum β-lactamase producing Enterobacterales in Swiss solid organ transplant recipients between 2012 and 2018

Köhler

Wolfensberger

Stampf

et al. 2021

Antimicrob Resist Infect Control

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Background The burden of antimicrobial resistance is high in solid organ transplant (SOT) recipients. Among Swiss SOT recipients, we assessed temporal trends of ESBL-producing Enterobacterales (ESBL-E), identified risk factors for ESBL-E, and assessed the impact of resistance on patient outcome. Methods Data from the Swiss Transplant Cohort Study (STCS), a nationwide prospective cohort of SOT-recipients, were analysed. Temporal trends were described for ESBL-detection among Escherichia coli and non-Escherichia coli. In a nested case–control study, cases with ESBL-E infection were 1:1 matched (by time since transplantation, organ transplant, pathogen) to controls infected with non-ESBL-E. Factors associated with resistance and with unfavourable 30-day outcome (death, infection relapse, graft loss) were assessed. Results From 2012 to 2018, we identified 1′212 infection episodes caused by Enterobacterales in 1′074 patients, thereof 11.4% (138/1′212) caused by ESBL-E. The proportion of ESBL-production among Escherichia coli remained stable over time (p = 0.93) but increased for non-E. coli (p = 0.02) Enterobacterales. In the case–control study (n = 102), antibiotic pre-treatment was independently associated with ESBL-production (aOR = 2.6, 95%-CI: 1.0–6.8, p = 0.046). Unfavourable outcome occurred in 24/51 (47%) cases and 9/51 (18%) controls (p = 0.003). Appropriate empiric antibiotic therapy was the only modifiable factor associated with unfavourable outcome. Conclusions In Swiss SOT-recipients, proportion of infections with ESBL-producing non-E. coli Enterobacterales increased in recent years. Antibiotic pre-treatment represents a risk factor for ESBL-E. Improving appropriateness of empiric antibiotic treatment might be an important measure to reduce unfavourable outcome, which was observed in almost half of SOT-recipients with ESBL-E infections.

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Section: Introductionmentioning

confidence: 99%

Temporal trends, risk factors and outcomes of infections due to extended-spectrum β-lactamase producing Enterobacterales in Swiss solid organ transplant recipients between 2012 and 2018

Köhler

Wolfensberger

Stampf

et al. 2021

Antimicrob Resist Infect Control

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“…Alevizakos et al [14] showed in a meta-analysis an extendedspectrum beta-lactamase-producing Enterobacterales (ESBL-E) rectal colonization rate of 17% among liver transplant recipients and 24% among kidney transplant recipients. Carbapenemaseproducing Enterobacterales (CPE) colonization varies between 2.5% in liver recipients and 10.8% in kidney recipients [15].…”

Section: Discussionmentioning

confidence: 99%

“…A major concern related to decolonization with oral antibiotics is resistance, as it could be associated with further development of antimicrobial resistance to the drugs used [14,15,17,22,27,28]. Colistin resistance in the rectal flora was detected in three liver recipients in the DT group and in one liver recipient in the NDT group, none of whom developed MDR-E infection.…”

Section: Discussionmentioning

confidence: 99%

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Oral decontamination with colistin plus neomycin in solid organ transplant recipients colonized by multidrug-resistant Enterobacterales: a multicentre, randomized, controlled, open-label, parallel-group clinical trial

Fariñas

González-Rico

Fernández-Martínez

et al. 2021

Clinical Microbiology and Infection

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“…Infections due to Gram-negative bacteria are nowadays the foremost cause of infection, their peak incidence occur early in post-transplant, typically within the first month [1,4,5] . Among these, Gram-negative carbapenem resistant (GNCR) strains associated bloodstream infection (BSIs) are a serious hazard for the patient's life [1,6,7], being rectal colonization with resistant strains associated with the occurrence of BSIs in the early post-transplant period [8][9][10]. There are no clear effective preventive measures to prevent GNCR infections after SOT in colonized patients.…”

Section: Introductionmentioning

confidence: 99%

Bloodstream infection reduction rate within the first month after heart and lung transplant with broader spectrum antimicrobial prophylaxis

Seminari¹,

Silvestri²,

Matteo³

et al. 2020

Trends in Transplant

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Introduction: Bloodstream infections (BSIs) occur early in the post transplant period, the aim of this retrospective study was to evaluate whether a broather antimicrobial prophylaxis at transplant could be helpful in reducing BSI incidence. Method:All BSI episodes occurring considered as early (until 30 days after transplant) or late events (from 31days to 365 days after transplant) were recorded. Before October 1st, 2018, vancomycin was used as prophylaxis at transplant (period 1); after October 1st,2018 prophylaxis included vancomycin and piperacillin/tazobactam (period 2) or a targeted prophylaxis according to the colonization bacteria detected through rectal swab.Results: One-hundred-fifteen patients received a SOT during the study (77 in period 1 and 38 in period 2),73 (63.5%) heart recipients, and 42 (36.5%) lung recipients. Fifty-four BSI episodes were recorded in 41 patients (36.7%). Gram-negative bacteria were responsible for the majority of BSIs. Twenty-four patients died during the study timeframe (22%) (type of SOT: 18 heart, 6 lung transplanted patients), having a BSI was a risk factor for death (HR 5.2; 95% CI 2.1-12-5, p<0.001).BSIs in the first 30 days after transplant accounted for 48% of all events. Overall BSI incidence rate was 1.15 per 100 patient/days in the first 30 days after transplant; 1.49 per 100 patient/days in period 1 and 0.58 per 100 patient/days in period 2. The use of broader antimicrobial prophylaxis was associated with reduced BSI in period 2 compared to period 1 (HR 0.39; 95%CI 0.16-0.93, p=0.035); CKD was associated with increased BSI risk (HR 2.45; 95% CI 1.1-6, p=0.048). At multivariate analysis the risk of BSI still remained reduced in period 2 (HR 0.38; 95%CI 0.14-1, p=0.05). BSI incidence between 31 and 365 days after transplant was 0.15 per 100 patient/days, age remained associated to BSI in the late period at multivariate analysis. Discussion: Broader antimicrobial prophylaxis at transplant is an option to reduce BSI incidence in the first month after transplant.

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Colonization with extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae in solid organ transplantation: A meta‐analysis and review

Abstract: Among SOT patients, approximately one in five patients is colonized with ESBL-E, although this finding may be skewed by reporting bias from centers with high ESBL-E prevalence. ESBL-E screening in SOT patients should be considered and evaluated in future studies.

Cited by 21 publications

References 37 publications

Temporal trends, risk factors and outcomes of infections due to extended-spectrum β-lactamase producing Enterobacterales in Swiss solid organ transplant recipients between 2012 and 2018

Temporal trends, risk factors and outcomes of infections due to extended-spectrum β-lactamase producing Enterobacterales in Swiss solid organ transplant recipients between 2012 and 2018

Oral decontamination with colistin plus neomycin in solid organ transplant recipients colonized by multidrug-resistant Enterobacterales: a multicentre, randomized, controlled, open-label, parallel-group clinical trial

Bloodstream infection reduction rate within the first month after heart and lung transplant with broader spectrum antimicrobial prophylaxis

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