Drug Resistance and Risk Factors for Acquisition of Gram-Negative Bacteria and Carbapenem-Resistant Organisms Among Liver Transplant Recipients

Abstract

Introduction: Infections caused by Gram-negative bacteria, in particular carbapenem-resistant organisms (CRO), pose a great threat to liver transplant (LT) recipients. Understanding the risk factors for Gram-negative and CRO infections and the drug resistance of corresponding bacteria will help guide the prevention and treatment of these infections.Methods: Data on the composition, distribution and drug resistance of Gram-negative bacteria and CRO among LT recipients were collected. The risk factors for Gram-negative and CRO infections were identified via univariate and multivariate analysis. Results: A total of 45 episodes of Gram-negative infection, including 20 episodes of CRO infection, occurred in 19.9% (27/136) of LT recipients. Klebsiella pneumoniae was the dominant pathogenic bacteria (14/45; 31.1%). The most common site of infection was the abdominal cavity/bile duct (11/27; 40.7%). Eleven (8.1%) patients died within 2 months after LT, and two deaths were related to Gram-negative infection. Gram-negative bacteria were relatively sensitive to tigecycline and polymyxin B, with resistance of 26.7 and 11.1%, respectively. CRO had lower resistance to ceftazidime/ avibactam (45.5%) and polymyxin B (10%). A univariate analysis showed that male sex, infection within 2 months prior to LT, duration of surgery C 400 min, reoperation, indwelling urethral catheter use C 3 days and elevated alanine aminotransferase on day 1 post-LT were associated with Gram-negative infection. Multivariate logistic regression analysis revealed that infection within 2 months prior to LT [odds ratio (OR) = 4.426, 95%CI: 1.634-11.99, P = 0.003], duration of surgery C 400 min

Epidemiology and Prevention of Early Infections by Multi-Drug-Resistant Organisms in Adults Undergoing Liver Transplant: A Narrative Review

“…This increment was mostly due to the emergence of ESBLE. ESBLE is a major concern as one-year survival post-LT rates were lower than patients with non-MDRO infections [ 40 , 41 , 42 ].…”

Role of a Real-Time TDM-Based Expert Clinical Pharmacological Advice Program in Optimizing the Early Pharmacokinetic/Pharmacodynamic Target Attainment of Continuous Infusion Beta-Lactams among Orthotopic Liver Transplant Recipients with Documented or Suspected Gram-Negative Infections

“…Several studies have shown that Gram-negative infections have a major role during the early post-OLT period, with pneumonia, bacteremia, and intrabdominal infections being the most frequent ones [1,[4][5][6][7][8][9][10][11]20,21]. In this scenario, beta-lactams are first-line treatments [12], and attaining an optimal PK/PD target early may allow for the maximization of clinical efficacy and suppress resistance development with beta-lactams [17,18].…”

“…Unfortunately, recent studies have reported that the infection rate after DCD OLT was remarkable, involving approximatively 70% of cases [3]. Bloodstream infections (BSIs) and ventilator-associated pneumonia (VAP) caused by Gram-negative pathogens represent the most frequent types of infection in early post-OLT surgery during intensive care unit (ICU) stays [4][5][6][7][8][9][10][11].…”

Infectious complications as prognostic factors for negative outcomes of liver transplantation

“…В 6 из 14 летальных исходов от сепсиса возбудителем была полирезистентная K. pneumoniae [7]. В спектре основных патогенов до 2013 г. преобладали E. coli и P. aeruginosa, затем их сменила полирезистентная K. pneumoniae, часто в сочетании с инвазивным кандидозом [8][9][10]. После ретрансплантации частота тяжелых осложнений и госпитальная летальность были больше, чем после первичной ОТП [11].…”