Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia

Pérez‐Nadales, Elena; Gutiérrez‐Gutiérrez, Belén; Natera, Alejandra M.; Abdala, Edson; Magalhães, Maira Reina; Mularoni, Alessandra; Monaco, Francesco; Pierrotti, Lı́gia Camera; Freire, Maristela Pinheiro; Iyer, Ranganathan; Steinke, Seema Mehta; Calvi, Elisa; Tumbarello, Mario; Falcone, Marco; Fernández‐Ruiz, Mario; Costa-Mateo, José María; Rana, Meenakshi; Strabelli, Tânia Mara Varejão; Fariñas, María Carmen; Clemente, Wanessa Trindade; Roilides, Emmanuel; Muñóz, Patricia; Dewispelaere, Laurent; Loeches, Belén; Lowman, Warren; Tan, Ban Hock; Escudero-Sánchez, Rosa; Bodro, Marta; Grossi, Paolo; Soldani, Fabio; Günseren, Filiz; Nestorova, Nina; Pascual, Álvaro; Martı́nez-Martı́nez, Luis; Aguado, José María; Torre‐Cisneros, Julián

doi:10.1111/ajt.15769

Cited by 18 publications

(29 citation statements)

References 30 publications

(59 reference statements)

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“…3,4 Emergence of resistance to CRE-active agents such as polymixins, tigecycline, and ceftazidimeavibactam has also been reported, further limiting therapeutic options for patients with CRE infections. [5][6][7][8][9][10][11] Solid organ transplantation (SOT) is an independent risk factor for CRE infection. 3 The rate of CRE infections in the SOT population varies by region and organ transplanted.…”

Section: Backg Rou N Dmentioning

confidence: 99%

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Impact of pre‐transplant carbapenem‐resistant Enterobacterales colonization and/or infection on solid organ transplant outcomes

Taimur

Pouch

Zubizarreta

et al. 2021

Clinical Transplantation

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The impact of pre-transplant (SOT) carbapenem-resistant Enterobacterales (CRE) colonization or infection on post-SOT outcomes is unclear. We conducted a multi-center, international, cohort study of SOT recipients, with microbiologically diagnosed CRE colonization and/or infection pre-SOT. Sixty adult SOT recipients were included (liver n = 30, hearts n = 17). Klebsiella pneumoniae (n = 47, 78%) was the most common pre-SOT CRE species. Median time from CRE detection to SOT was 2.32 months (IQR 0.33-10.13). Post-SOT CRE infection occurred in 40% (n = 24/60), at a median of 9 days (IQR 7-17), and most commonly due to K pneumoniae (n = 20/24, 83%). Of those infected, 62% had a surgical site infection, and 46% had bloodstream infection.Patients with post-SOT CRE infection more commonly had a liver transplant (16, 67% vs. 14, 39%; p =.0350) or pre-SOT CRE BSI (11, 46% vs. 7, 19%; p =.03). One-year post-SOT survival was 77%, and those with post-SOT CRE infection had a 50% less chance of survival vs. uninfected (0.86, 95% CI, 0.76-0.97 vs. 0.34, 95% CI 0.08-1.0, p =.0204). Pre-SOT CRE infection or colonization is not an absolute contraindication to SOT and is more common among abdominal SOT recipients, those with pre-SOT CRE BSI, and those with early post-SOT medical and surgical complications. K E Y W O R D S carbapenem-resistant enterobacterales, multidrug-resistant organisms, solid organ transplantation How to cite this article: Taimur S, Pouch SM, Zubizarreta N, et al. Impact of pre-transplant carbapenem-resistant Enterobacterales colonization and/or infection on solid organ transplant outcomes.

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Section: Backg Rou N Dmentioning

confidence: 99%

“…Emergence of resistance to CRE‐active agents such as polymixins, tigecycline, and ceftazidime‐avibactam has also been reported, further limiting therapeutic options for patients with CRE infections. 5‐11 …”

Section: Introductionmentioning

confidence: 99%

Impact of pre‐transplant carbapenem‐resistant Enterobacterales colonization and/or infection on solid organ transplant outcomes

Taimur

Pouch

Zubizarreta

et al. 2021

Clinical Transplantation

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“…Interestingly, the patients with CMV in each group were relatively young with a mean age of 40-44 years. This may be because non-transplant patients with various comorbidities may have a higher risk of adverse outcomes with CMV end-organ disease than SOT recipients, although post-SOT CMV disease could also be attributable to morbidity and mortality 30 , 31 , 49 . The relatively high all-cause mortality in individuals without transplantation might be related to the various co-morbid illnesses, especially ESRD on dialysis, chronic lung diseases, and HIV-1 infection, and/or the indirect effects of CMV disease, including the risk of infections by other bacteria or fungi 20 , 30 , 50 .…”

Section: Discussionmentioning

confidence: 99%

The Incidence and Effect of Cytomegalovirus Disease on Mortality in Transplant Recipients and General Population: Real-world Nationwide Cohort Data

Han¹,

Yoo²,

Han³

et al. 2021

Int. J. Med. Sci.

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Background : In addition to the conventional opportunistic infections in solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) recipients, cytomegalovirus (CMV) infection is associated with various chronic inflammatory diseases or poor outcomes in non-immunocompromised critically ill patients. To evaluate the burden or outcome of CMV replication in non-transplant individuals, we compared the incidence rates (IRs) for CMV disease and all-cause mortality between SOT recipients, HSCT recipients, and non-transplant population. Methods : The SOT (N=16,368) and HSCT (N=10,206) cohorts between 2010 and 2015 were established using the WHO ICD-10 from the whole population-based large database of the Health Insurance Review & Assessment Service (HIRA). CMV cases, defined as symptomatic disease with isolation of virus, DNA, pp65 antigen, and pathology except CMV syndrome, were extracted with the unique codes for relief of medical costs of HIRA in the same dataset. Cox's proportional hazard regression analyses and log-rank test in the Kaplan-Meier curves were performed to compare all-cause mortality between the three groups. Results : The CMV IRs adjusted by age and sex were significantly higher in the SOT (adjusted IR [95% confidence intervals], 33.1 [28.8-38.0] per 1,000 person-years) and HSCT recipients (5.1 [4.6-6.1] per 1,000 person-years) than in the whole population (0.58 [0.49-0.67] per 100,000 person-years). However, SOT recipients with CMV (18/283, 6.4%) had significantly lower all-cause mortality than non-transplant individuals with CMV (207/1,258, 16.5%) (adjusted hazard ratio [95% CI], 0.42 [0.25-0.67], log-rank P < 0.001). Conclusion : These data suggest that CMV disease in patients without transplants is associated with poor outcomes.

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“…Belén Gutiérrez-Gutiérrez 1,2 Elena Pérez-Nadales 1,3 Jesús Rodríguez-Baño 1,2 Julián Torre-Cisneros 1,3…”

Section: I Sclos U R Eunclassified

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Gutiérrez‐Gutiérrez

Pérez‐Nadales

Rodríguez‐Baño

et al. 2020

American Journal of Transplantation

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We thank Ferhat Arslan 1 for this letter. Biological significance is certainly the most important aspect in biomedical research; however, statistics provide a powerful tool to reveal associations between biological variables. In our study, 2 we aimed to identify predictor variables for mortality in solid organ transplant recipients with carbapenemase-producing Enterobacteriaceae-bloodstream infections (CPE-BSI) regardless of their causal associations and to analyze the predictive capacity of the model. However, in this case, we consider

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Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia

Abstract: Elena Pérez-Nadales and Belén Gutiérrez-Gutiérrez have contributed equally to this work.Investigators listed in Acknowledgments.

Cited by 18 publications

References 30 publications

Impact of pre‐transplant carbapenem‐resistant Enterobacterales colonization and/or infection on solid organ transplant outcomes

Impact of pre‐transplant carbapenem‐resistant Enterobacterales colonization and/or infection on solid organ transplant outcomes

The Incidence and Effect of Cytomegalovirus Disease on Mortality in Transplant Recipients and General Population: Real-world Nationwide Cohort Data

Reply to “CMV merits further evolutionary and biological view”

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