Impact of deceased donor multidrug-resistant bacterial organisms on organ utilization

Abstract

The extent to which donor multidrug‐resistant organisms (MDROs) affect organ utilization remains unclear. We performed a retrospective cohort study at 4 transplant centers between 2015 and 2016 to evaluate this question. All deceased donors who donated at least one organ were included. Exposed donors had at least one MDRO on culture. Unexposed donors had no MDRO‐positive cultures. Only cultures obtained during the donor's terminal hospitalization were evaluated. Multivariable regression was used to determine the association between donor MDRO and (1) number of organs transplanted per donor and (2) the match run at which each organ was accepted. Subsequently, we restricted the analysis to donors with MDR‐Gram‐negative (GN) organisms. Of 440 total donors, 29 (7%) donors grew MDROs and 7 (2%) grew MDR‐GNs. There was no significant association between donor MDRO and either measure of organ utilization. However, donor MDR‐GNs were associated with a significant reduction in the number of organs transplanted per donor (incidence rate ratio 0.43, 95% confidence interval [CI] 0.39‐0.48, P < .01), and organs were accepted significantly further down the match list (relative count 5.08, 95% CI 1.64‐15.68, P = .01). Though donor MDR‐GNs were infrequent in our study, their growing prevalence could meaningfully reduce the donor pool over time.

Impact of donor multidrug‐resistant organisms on solid organ transplant recipient outcomes

“…2,3,5 The lack of association in our study may have again been due to limited power (6% of SOT recipients had a donor with an MDR-Gram negative on culture), but it is not routine practice at the included study sites to treat all MDR-Gram negatives on donor cultures in the recipient, unless identified from the blood or allograft, so our results do raise the question of whether MDR-Gram negatives on donor culture may be less threatening than perceived. 8 Conversely, we did find an association between donor VRE and recipient infection in our unadjusted secondary analyses, suggesting further study of the impact of donor VRE on recipient outcomes is needed. 25 Additionally, future studies evaluating how antimicrobials administered to the recipient affect the association between donor MDROs and recipient infections are needed to better understand these outcomes.…”

“…Prior work from our group has shown a notable reduction in organ utilization when MDR-Gram negative organisms are identified on donor culture. 8 Further, MDROs are increasingly being observed among the deceased donor cohort. We have previously reported that approximately 15% of deceased organ donors have at least one MDRO identified on peri-procurement cultures.…”

Colistin Sulfate for Decontamination of Preservation Fluid to Decrease Donor-derived Infections Caused by Multi-drug Resistant Gram-negative Pathogens

“…The case-fatality rate was regarded as death by any cause within the rst 30 days of the onset of infection [10]. MDR Gram-negative refers to extended-spectrum cephalosporin-resistant Enterobacterales, carbapenem-resistant Enterobacterales (CRE), MDR Pseudomonas aeruginosa, and MDR Acinetobacter baumannii [11].…”

Machine perfusion combined with antibiotics prevents donor-derived infections caused by multidrug-resistant bacteria

“…[12][13][14] In general, controversy remains over the selection and treatment of organs from infected donors. [15][16][17][18][19] A few guidelines recommend that infected donors receive targeted antimicrobial therapy for at least 24-48 h and recipients should be treated with at least a 7-day course of antibiotic targeted to the organism isolated from the donors. 2,20,21 Nevertheless, treating donors and recipients with prolonged and/ or recurrent antibiotic treatment could promote the emergence of MDR bacteria, cause the uptake and metabolism of suboptimal drugs, including immunosuppressants, and carry the risk of side effects on the other organ systems.…”

“…Some reports have revealed 3%–10% incidence of CRKP infection in recipients of solid organ transplant with mortality rates ranging from 22% to 72% 12–14 . In general, controversy remains over the selection and treatment of organs from infected donors 15–19 . A few guidelines recommend that infected donors receive targeted antimicrobial therapy for at least 24–48 h and recipients should be treated with at least a 7‐day course of antibiotic targeted to the organism isolated from the donors 2,20,21 .…”