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

Abstract

Background:The impact of donor colonization or infection with multidrug-resistant organisms (MDROs) on solid organ transplant (SOT) recipient outcomes remains uncertain. We thus evaluated the association between donor MDROs and risk of posttransplant infection, graft failure, and mortality.Methods: A multicenter retrospective cohort study was performed. All SOT recipients with a local deceased donor were included. The cohort was divided into three exposure groups: recipients whose donors had (1) an MDRO, (2) a non-MDRO bacterial or candidal organism, or (3) no growth on cultures. The primary outcomes were (1) bacterial or invasive candidal infection within 3 months and (2) graft failure or death within 12 months posttransplant. Mixed effect multivariable frailty models were developed to evaluate each association.Results: Of 658 total SOT recipients, 93 (14%) had a donor with an MDRO, 477 (73%) had a donor with a non-MDRO organism, and 88 (13%) had a donor with no organisms on culture. On multivariable analyses, donor MDROs were associated with a significantly increased hazard of infection compared to those with negative donor cultures (adjust hazard ratio [aHR] 1.63, 95% CI 1.01-2.62, p = .04) but were not associated with graft failure or death (aHR 0.45, 95% CI 0.15-1.36, p = .16).

Role of bacteriophage therapy for resistant infections in transplant recipients

“…Cystic fibrosis (CF) patients awaiting lung transplant have high rates of MDR Pseudomonas and Mycobacterium abscessus, whilst many centres list the presence of Burkholderia cepacia complex as a contraindication to lung transplant [19][20][21]. The presence of MDROs is associated with worse illness [22] and increased mortality while awaiting transplant, but there are mixed reports of changes in posttransplant outcomes [23][24][25][26][27].…”

Extended‐spectrum β‐lactamase‐producing and carbapenem‐resistant Enterobacterales bloodstream infection after solid organ transplantation: Recent trends in epidemiology and therapeutic approaches

“…Risk factors for developing post‐transplant ESBL‐E infection include previous antibiotic exposure, pre‐transplant colonization, perioperative prophylaxis, prolonged tracheal intubation, long‐term hospitalization, urinary tract obstruction and instrumentation, kidney‐pancreas transplantation, post‐transplant renal replacement therapy (RRT), and recurrent urinary tract infection (UTI), as reviewed elsewhere 3,19 . A recent multicenter case‐control study in the USA comprising 988 ESBL‐E BSI episodes identified various risk factors of relevance, including the isolation of ESBL‐E in a prior culture, a corticosteroid‐containing immunosuppression regimen, acute rejection treated with corticosteroids, and previous exposure to third‐generation cephalosporins, echinocandins and trimethoprim‐sulfamethoxazole 20 …”

Deceased donors with multidrug-resistant organisms: implications and future directions

“…One factor which may contribute to MDRO DDI overall is the limited availability of donor culture data at the time of organ recovery. In this context, standard perioperative prophylaxis at the time of transplantation has limited activity against the majority of MDROs, apart from MRSA when vancomycin is administered [23 ▪ ]. Additionally, prompt communication of donor culture results is imperative, and it is unclear to what degree communication delays may have contributed to transmissions in the above reports.…”