Extended Spectrum β-Lactamase–Producing Enterobacteriaceae Infection in Heart and Lung Transplant Recipients and in Mechanical Circulatory Support Recipients

Bui, Kevin T.; Mehta, Seema; Khuu, T.; Ross, David J.; Carlson, Margrit; Leibowitz, Matthew; Schaenman, Joanna; Saggar, Rajan; Lynch, Joseph P.; Ardehali, A.; Kubak, B.

doi:10.1097/01.tp.0000436928.15650.59

Cited by 21 publications

(19 citation statements)

References 10 publications

(5 reference statements)

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“…Significantly, MDR pathogens were present in 47% of patients. Extendedspectrum ESBL-producing gram-negative organisms have been reported in 2.2% of heart transplant recipients [12], whereas we noted two ESBL infections (3.9%).…”

Section: Discussioncontrasting

confidence: 60%

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Outcomes and Predictors of Early Infection after Heart Transplantation

Shultes

Shuster

Micek

et al. 2018

Surgical Infections

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Section: Discussioncontrasting

confidence: 60%

“…Bacterial infections continue to be the most common type of severe infections [4,[6][7][8][9], with gram-positive organisms being the primary infecting pathogens [6]. Interest in blactamase-producing Enterobacteriaceae and fungal infections in this patient population also has emerged recently [10][11][12].…”

mentioning

confidence: 99%

Outcomes and Predictors of Early Infection after Heart Transplantation

Shultes

Shuster

Micek

et al. 2018

Surgical Infections

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“…Our study provides comprehensive information on aetiological changes over time in SOT recipients with BSI. At the same time, the higher rates of antimicrobial resistance concur with data from recent studies, which report much higher rates of antibiotic resistance in GNB in their series and reflect the growing concern with antibiotic resistance worldwide . SOT patients are particularly prone to MDR bacterial infections, probably due to their frequent manipulation and the use of antibiotics and devices .…”

Section: Discussionsupporting

confidence: 86%

“…In summary, we report significant changes in the aetiology of BSI within the first year after SOT. Today, GNB are the leading causative agents of BSI in SOT Days of intravenous antibiotic therapy (median, IQR) 11 (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) 11 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) 9 (6-20) 12 (7)(8)(9)(10)(11)(12)(13)(14)(15) 11 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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“…The overall incidence of ESBL‐producing K. pneumoniae infection in the liver was lower than in renal transplant recipients (7% vs. 11%, respectively) . In heart and lung transplant patients, the sources of ESBL infections include bacteraemia, urinary tract infections, pneumonia, central venous catheter‐associated infection and wound infections, but the overall incidence was lower (2.2% and 5.5%, respectively) .…”

Section: Mdr Pathogens In Solid Organ Transplant Recipientsmentioning

confidence: 96%

Multidrug-resistant bacteria in solid organ transplant recipients

Cervera

Delden

Gavaldá

et al. 2014

Clinical Microbiology and Infection

146

111

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Bacteria are the leading cause of infections after solid organ transplantation. In recent years, a progressive growth in the incidence of multidrug-resistant (MDR) and extensively-drug-reistant (XDR) strains has been observed. While methicillin-resistant Staphylococcus aureus (MRSA) infection is declining in non-transplant and SOT patients worldwide, vancomycin-resistant enterococci, MDR/XDR Enterobacteriaceae and MDR/XDR non-fermenters are progressively growing as a cause of infection in solid organ transplant (SOT) patients and represent a global threat. Some SOT patients develop recurrent infections, related to anatomical defects in many cases, which are difficult to treat and predispose patients to the acquisition of MDR pathogens. As the antibiotics active against MDR bacteria have several limitations for their use, which include less clinical experience, higher incidence of adverse effects and less knowledge of the pharmacokinetics of the drug, and, in most cases, are only available for parenteral administration, it is mandatory to know the main characteristics of these drugs to safely treat SOT patients with MDR bacterial infections. Nonetheless, preventive measures are the cornerstone of controlling the spread of these pathogens. Thus, applying the Center for Disease Control and Prevention's and the European Society of Clinical Microbiology and Infectious Diseases's recommended antibiotic policies and strategies to control the transmission of MDR strains in the hospital setting is essential for the management of SOT patients.

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Extended Spectrum β-Lactamase–Producing Enterobacteriaceae Infection in Heart and Lung Transplant Recipients and in Mechanical Circulatory Support Recipients

Abstract: Early detection and adequate duration of therapy for ESBL-producing Enterobacteriaceae in solid organ transplants and MCS device recipients are essential in successful patient outcomes including prevention of recurrent infection.

Cited by 21 publications

References 10 publications

Outcomes and Predictors of Early Infection after Heart Transplantation

Outcomes and Predictors of Early Infection after Heart Transplantation

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

Multidrug-resistant bacteria in solid organ transplant recipients

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