MRSA and VRE Colonization in Solid Organ Transplantation: A Meta-Analysis of Published Studies

Ziakas, Panayiotis D.; Pliakos, Elina Eleftheria; Zervou, Fainareti N.; Knoll, Bettina M.; Rice, Louis B.; Mylonakis, Elefterios

doi:10.1111/ajt.12784

Cited by 104 publications

(97 citation statements)

References 49 publications

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“…Most studies exploring the risk factors, prevalence, and incidence of MRSA in LT are single‐center evaluations from the United States in the setting of active surveillance . MRSA infection reportedly occurs in 4%‐23% of LT recipients though more contemporary studies suggest lower rates .…”

Section: Methicillin‐resistant Staphylococcus Aureusmentioning

confidence: 99%

Multidrug‐resistant organisms in liver transplant: Mitigating risk and managing infections

Hand

Patel

2016

Liver Transpl

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Liver transplant (LT) recipients are vulnerable to infections with multidrug-resistant (MDR) pathogens. Risk factors for colonization and infection with resistant bacteria are ubiquitous and unavoidable in transplantation. During the past decade, progress in transplantation and infection prevention has contributed to the decreased incidence of infections with methicillin-resistant Staphylococcus aureus. However, even in the face of potentially effective antibiotics, vancomycinresistant enterococci continue to plague LT. Gram-negative bacilli prove to be more problematic and are responsible for high rates of both morbidity and mortality. Despite the licensure of novel antibiotics, there is no universal agent available to safely and effectively treat infections with MDR gram-negative organisms. Currently, efforts dedicated toward prevention and treatment require involvement of multiple disciplines including transplant providers, specialists in infectious diseases and infection prevention, and researchers dedicated to the development of rapid diagnostics and safe and effective antibiotics with novel mechanisms of action.Liver Transplantation 22 1143-1153 2016 AASLD. Even with great improvements in infection prevention, surgical technique, and immunosuppression, bacterial infections remain responsible for poor outcomes in liver transplantation (LT). In an era of prolonged wait times, repeated and unavoidable exposures to both health care and antibiotics place LT candidates and recipients at high risk for both colonization and infection with multidrug-resistant organisms (MDROs).Multidrug resistance is frequently defined as bacteria resistant to at least 1 agent in at least 3 different antibiotic classes.(1) Despite this accepted definition, the definitions applied in studies describing MDROs are variable. MDRO colonization has been associated with subsequent infection and surgical complexities, requirement for immunosuppressive therapy, and necessary invasive interventions (eg, central venous catheters, urinary catheters, and mechanical ventilation) also add to the risk of MDRO infection in this susceptible population. In the absence of posttransplant complications, bacterial infections are more common early after LT.(2) Donor transmission of a MDRO has rarely been reported.Delays in effective empirical therapy, lack of experience with older and newer agents, and ever-changing susceptibility profiles in the setting of inadequate source control or selective antibiotic pressures contribute to the difficulties in treating patients infected with MDROs, specifically multidrug-resistant (MDR) gram-negative bacilli. In this review, we highlight risk factors and available treatment for some of the more common and problematic MDROs encountered in LT.

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Section: Methicillin‐resistant Staphylococcus Aureusmentioning

confidence: 99%

Multidrug‐resistant organisms in liver transplant: Mitigating risk and managing infections

Hand

Patel

2016

Liver Transpl

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“…Therefore, it is necessary for patients to be checked for these resistant isolates before transplant and for necessary actions to be taken to remove them. 5 In the present study, of 5 Staphylococcus aureus isolates, 2 cases were identified as MRSA; of 6 Enterococcus isolates, 2 cases were identified as VRE.…”

Section: Discussionmentioning

confidence: 45%

“…In addition to development of resistance to these antibiotics, colonization in patients before and after transplant plays a major role in incidence of infection after transplant. In a meta-analysis conducted in 2014 by Ziakas and colleagues, 5 the MRSA colonization rate in patients was 8.5% and colonization rates of VRE in transplant patients before and after surgery were 11.9% and 16.2%. This showed that infection after transplant in these patients was approximately 6 to 10 times higher than in other patients.…”

Section: Discussionmentioning

confidence: 99%

“…4 In addition to gram-negative bacteria, some gram-positive bacteria, including Staphylococcus and Enterococcus species, are known to cause infection in these patients. 5 The primary concern in the treatment of these infections is resistance of bacteria to antimicrobial agents through different mechanisms. For example, resistance in gram-negative bacteria mostly occurs through extended-spectrum beta-lactamases (ESBLs) and carbapenemase enzymes.…”

Section: Introductionmentioning

confidence: 99%

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Untitled

Mansury

Khaledi²,

Ghazvini³

et al. 2018

Exp Clin Transplant

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Objectives: Over the past 2 decades, significant advances have been made in the management of infections after transplant; however, transplant recipients are still at high risk of infectious complications. This study aimed to evaluate the prevalence of bacterial infections and antimicrobial resistance patterns in kidney transplant recipients. Conclusions:Because of the high prevalence of infection among transplant patients, infection prevention should receive more attention, and antibiotic susceptibility should be determined before treatment. Key words: Antibiotic resistance, Coagulase-negative Staphylococcus, Escherichia coli, Renal transplantation IntroductionOne of the primary and major aims in organ transplant is the effective prevention and treatment of infections. During the previous 2 decades, significant advances have been made in the management of infection after transplant. However, transplant recipients are still at high risk of infectious complications, due to the surgical interventions, immunosuppressive therapy, and exposure to the environment. 1 In transplant patients, there are generally 3 times the incidences of infections after transplant, which are usually divided as those that occur during the first month posttransplant, those that occur 2 to 6 months posttransplant, and those that occur more than 6 months posttransplant.Most infections in the first month, especially the first 2 weeks after transplant, occur in relation to technical and operative factors. These infections include pneumonia, wound infection, those related to intravenous catheter, and urinary tract infection. 2 In addition are complications that result from infections causing the death of organ transplant recipients and in some cases organ transplant rejections, especially infections that are caused by drug-resistant bacteria. [2][3][4] Urinary tract infections are the most common problem after kidney transplant. Almost 70% of these infections are caused by gramnegative bacteria, especially Escherichia coli and Klebsiella pneumoniae. 4 In addition to gram-negative bacteria, some gram-positive bacteria, including

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“…The prevalence of vancomycin-resistant Enterococcus (VRE) post-transplantation is on average 11.9%, ranging from 6.8% to 18.2%. (7) In our service this agent was identified in 11% of cases of the infections in the first month after LT, and vancomycin resistance was detected in 42% of the cases. (12) The predisposing factors to Enterococcus spp.…”

mentioning

confidence: 88%

Aquisição de bactéria gram-negativa multidroga resistente antes do transplante de fígado: o impacto no desfecho

Freire¹

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MRSA and VRE Colonization in Solid Organ Transplantation: A Meta-Analysis of Published Studies

Cited by 104 publications

References 49 publications

Multidrug‐resistant organisms in liver transplant: Mitigating risk and managing infections

Multidrug‐resistant organisms in liver transplant: Mitigating risk and managing infections

Untitled

Aquisição de bactéria gram-negativa multidroga resistente antes do transplante de fígado: o impacto no desfecho

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