Risk factors for multidrug-resistant organisms among deceased organ donors

Anesi, Judith A; Blumberg, Emily A.; Han, Jennifer H.; Lee, Dong Heun; Clauss, Heather; Climaco, Antonette; Hasz, Richard; Molnar, Esther; Alimenti, Darcy; West, Sharon; Bilker, Warren B.; Tolomeo, Pam; Lautenbach, Ebbing

doi:10.1111/ajt.15488

Cited by 25 publications

(31 citation statements)

References 46 publications

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“…Multidrug‐resistant organisms (MDRO) are an emerging area of concern in transplantation. Transmissions of MDROs have been associated with poor recipient outcomes 13,20,21 . Although DTAC data did not uniformly include antimicrobial susceptibility information, it is notable that among the 80 bacterial pathogens transmitted methicillin‐resistant Staphylococcus aureus (MRSA), vancomycin‐resistant Enterococcus (VRE), Acinetobacter spp ., Burkholderia , and Pseudomonas accounted for 29/80 (36%) of transmitted bacteria.…”

Section: Discussionmentioning

confidence: 99%

Ten years of donor-derived disease: A report of the disease transmission advisory committee

Kaul

Vece²,

Blumberg

et al. 2021

American Journal of Transplantation

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Despite clinical and laboratory screening of potential donors for transmissible disease, unexpected transmission of disease from donor to recipient remains an inherent risk of organ transplantation. The Disease Transmission Advisory Committee (DTAC) was created to review and classify reports of potential disease transmission and use this information to inform national policy and improve patient safety. From January 1, 2008 to December 31, 2017, the DTAC received 2185 reports; 335 (15%) were classified as a proven/probable donor transmission event. Infections were transmitted most commonly (67%), followed by malignancies (29%), and other disease processes (6%). Forty‐six percent of recipients receiving organs from a donor that transmitted disease to at least 1 recipient developed a donor‐derived disease (DDD). Sixty‐seven percent of recipients developed symptoms of DDD within 30 days of transplantation, and all bacterial infections were recognized within 45 days. Graft loss or death occurred in about one third of recipients with DDD, with higher rates associated with malignancy transmission and parasitic and fungal diseases. Unexpected DDD was rare, occurring in 0.18% of all transplant recipients. These findings will help focus future efforts to recognize and prevent DDD.

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Section: Discussionmentioning

confidence: 99%

Ten years of donor-derived disease: A report of the disease transmission advisory committee

Kaul

Vece²,

Blumberg

et al. 2021

American Journal of Transplantation

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“…Two recent studies corroborate these findings. The first study conducted in the US [51] reported 15% prevalence of MDRO-related infections in 440 solid organ donors, with Hepatitis C, dialysis, prior hematopoietic cell transplant, and exposure to antibiotics with a narrow Gramnegative spectrum acting as independent predictors. The second study carried out in Italy [52] investigated the prevalence of MDRO infections in 759 deceased donors.…”

Section: Multidrug Bacterial Infection Early After Liver Transplantationmentioning

confidence: 99%

Multidrug-Resistant Bacterial Infections before and after Liver Transplantation

Ferrarese¹,

Senzolo²,

Burra³

2020

OBM Transplantation

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Bacterial infection represents a common event in the natural history of cirrhosis, especially in patients with end-stage liver disease. An episode of bacterial infection may significantly modify a patient's outcome in the setting of liver transplantation (LT) by impairing hepatic and extrahepatic organ functions, both in pre-operative and post-operative phases. Infections caused by multidrug-resistant organisms (MDRO) are increasing in cirrhosis due to high antibiotic exposure and hospitalizations. This issue is particularly important in the LT setting, where MDRO infections occurring before surgery and during the early days after surgery might significantly impair graft function and patient outcome. This review summarizes the recently published findings on the occurrence of MDRO infection before and after LT, and new perspectives for its prevention and treatment.

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“…Further research is needed to understand the role of pre- and post-transplant screening as well as potential donor screening for resistant bacteria such as DRE. The latter is an emerging area of focus as antibiotic-experienced deceased donors have been shown to be at increased risk of colonization with multidrug-resistant organisms (MDROs) that can be transmitted to the recipient [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

Daptomycin-Resistant Enterococcus Bacteremia Is Associated With Prior Daptomycin Use and Increased Mortality After Liver Transplantation

Lee

Goldman

Haidar

et al. 2022

Open Forum Infectious Diseases

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Background Risk factors for acquisition of vancomycin-resistant Enterococcus (VRE) include immunosuppression, antibiotic exposure, indwelling catheters, and manipulation of the gastrointestinal tract, all of which occur in liver transplant recipients. VRE infections are documented in liver transplantation (LT); however, only one single center study has assessed the impact daptomycin-resistant Enterococcus (DRE) in this patient population. Methods We conducted a retrospective multicenter cohort study comparing liver transplant recipients with either VRE or DRE bacteremia. The primary outcome was death within one year of transplantation. Multivariable logistic regression analyses were performed to calculate adjusted odds ratios for outcomes of interest. Results We identified 139 cases of Enterococcus bacteremia following LT, of which 78% were VRE and 22% were DRE. When adjusted for total ICU days in the first transplant year, liver-kidney transplantation, and calcineurin inhibitor use, patients with DRE bacteremia were 2.65 times more likely to die within one year of transplantation (aOR 2.648 [1.025-6.840], p = 0.044). Prior daptomycin exposure was found to be an independent predictor of DRE bacteremia (aOR 30.62 (10.087-92.955), p <0.001). Conclusions In this multicenter study of LT recipients with Enterococcus bacteremia, DRE bacteremia was associated with higher 1-year mortality rates when compared to VRE bacteremia. Our data provide strong support for dedicated infection prevention and antimicrobial stewardship efforts for transplant patients. Further research is needed to support the development of better antibiotics for DRE and practical guidance focusing on identification and prevention of colonization and subsequent infection in liver transplant recipients at high risk for DRE bacteremia.

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Risk factors for multidrug-resistant organisms among deceased organ donors

Cited by 25 publications

References 46 publications

Ten years of donor-derived disease: A report of the disease transmission advisory committee

Ten years of donor-derived disease: A report of the disease transmission advisory committee

Multidrug-Resistant Bacterial Infections before and after Liver Transplantation

Daptomycin-Resistant Enterococcus Bacteremia Is Associated With Prior Daptomycin Use and Increased Mortality After Liver Transplantation

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