Carbapenem-resistant Acinetobacter baumannii Bacteremia in Liver Transplant Recipients

Kim, Y.J.; Kim, S.I.; Lee, Y.d.; Choi, Ho Joong; Choi, Jung‐Hyun; Yoon, Seung Kew; You, Yong‐Ouk; Kim, D.-G.

doi:10.1016/j.transproceed.2018.01.043

Cited by 19 publications

(14 citation statements)

References 17 publications

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“…On average, 40% of meropenem samples did not achieve a sufficient trough concentration of 8 mg/L. We thought that the chosen high breakpoints for target attainment were necessary due to the high number of immunocompromised patients who underwent lung or liver transplantation and had special pathogens with higher MICs than other patients [31,32]. The number of subtherapeutic levels was comparable to those reported in the literature for meropenem [17,33,34], piperacillin [7,35,36], and other beta-lactam antibiotics like cefepime [37] or ceftriaxone [38].…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Drug Monitoring of Meropenem and Piperacillin in Critical Illness—Experience and Recommendations from One Year in Routine Clinical Practice

et al. 2020

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Various studies have reported insufficient beta-lactam concentrations in critically ill patients. The extent to which therapeutic drug monitoring (TDM) in clinical practice can reduce insufficient antibiotic concentrations is an ongoing matter of investigation. We retrospectively evaluated routine meropenem and piperacillin measurements in critically ill patients who received antibiotics as short infusions in the first year after initiating a beta-lactam TDM program. Total trough concentrations above 8.0 mg/L for meropenem and above 22.5 mg/L for piperacillin were defined as the breakpoints for target attainment. We included 1832 meropenem samples and 636 piperacillin samples. We found that 39.3% of meropenem and 33.6% of piperacillin samples did not reach the target concentrations. We observed a clear correlation between renal function and antibiotic concentration (meropenem, r = 0.53; piperacillin, r = 0.63). Patients with renal replacement therapy or creatinine clearance (CrCl) of <70 mL/min had high rates of target attainment with the standard dosing regimens. There was a low number of patients with a CrCl >100 mL/min that achieved the target concentrations with the maximum recommended dosage. Patients with impaired renal function only required TDM if toxic side effects were noted. In contrast, patients with normal renal function required different dosage regimens and TDM-guided therapy to reach the breakpoints of target attainment.

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Section: Discussionmentioning

confidence: 99%

Therapeutic Drug Monitoring of Meropenem and Piperacillin in Critical Illness—Experience and Recommendations from One Year in Routine Clinical Practice

et al. 2020

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“…In a previous Korean single‐center study, CRAB‐B occurred in 14 of 393 patients (3.6%), with a 50% overall mortality rate, and the associated risk factors were identified; however, the median time to CRAB‐B was 55.5 (IQR 2−829) days 25 . Therefore, it is difficult to discuss the association with pre‐transplantation risk factors by analyzing these long‐term CRAB‐B cases.…”

Section: Discussionmentioning

confidence: 99%

Incidence, mortality, and risk factors associated with carbapenem‐resistant Acinetobacter baumannii bacteremia within 30 days after liver transplantation

Min

Yim

Choi

et al. 2023

Clinical Transplantation

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Carbapenem‐resistant Acinetobacter baumannii bacteremia (CRAB‐B) is a fatal infectious complication of liver transplantation (LT). This study investigated the incidence, effects, and risk factors associated with CRAB‐B during the early post‐LT period. Among 1051 eligible LT recipients, 29 patients experienced CRAB‐B within 30 days of LT with a cumulative incidence of 2.7%. In the patients with CRAB‐B (n = 29) and matched controls (n = 145) by nested‐case control design, the cumulative incidence of death on days 5, 10, and 30 from the index date was 58.6%, 65.5%, and 65.5%, and 2.1%, 2.8%, and 4.2%, respectively (p < .001). Pre‐transplant MELD (OR 1.11, 95% confidence interval [CI] 1.04–1.19, p = .002), severe encephalopathy (OR 4.62, 95% CI 1.24–18.61, p = .025), donor body mass index (OR .57, 95% CI .41–.75, p < .001), and reoperation (OR 6.40, 95% CI 1.19–36.82, p = .032) were independent risk factors for 30‐day CRAB‐B. CRAB‐B showed extremely high mortality within 30 days after LT, especially within 5 days after its occurrence. Therefore, assessment of risk factors and early detection of CRAB, followed by proper treatment, are necessary to control CRAB‐B after LT.

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“…Older recipient age, diabetes, chronic kidney disease, colonization with CRKP, a higher MELD score, mechanical ventilation, hemodialysis, exposure to cephalosporin, carbapenem, or piperacillin/tazobactam, hepatitis C virus recurrence and Roux-en-Y biliary choledochojejunostomy were introduced as risk factors for CRKP infections in previous studies [24,28,[38][39][40]. On the other hand, fulminant hepatitis as underlying disease, colonization with CRAB before LT, cold ischemia, dialysis following LT, post-LT length of ICU stay, prolonged central venous catheter use and previous exposure to any antibiotic including carbapenem might lead to post-LT CRAB infection [41,42].…”

Section: Studies By Mouloudi Et Al and Pereira Et Al Demonstrated Tha...mentioning

confidence: 99%

Drug Resistance and Risk Factors for Acquisition of Gram-Negative Bacteria and Carbapenem-Resistant Organisms Among Liver Transplant Recipients

Long

Peng

et al. 2022

Infect Dis Ther

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Introduction: Infections caused by Gram-negative bacteria, in particular carbapenem-resistant organisms (CRO), pose a great threat to liver transplant (LT) recipients. Understanding the risk factors for Gram-negative and CRO infections and the drug resistance of corresponding bacteria will help guide the prevention and treatment of these infections.Methods: Data on the composition, distribution and drug resistance of Gram-negative bacteria and CRO among LT recipients were collected. The risk factors for Gram-negative and CRO infections were identified via univariate and multivariate analysis. Results: A total of 45 episodes of Gram-negative infection, including 20 episodes of CRO infection, occurred in 19.9% (27/136) of LT recipients. Klebsiella pneumoniae was the dominant pathogenic bacteria (14/45; 31.1%). The most common site of infection was the abdominal cavity/bile duct (11/27; 40.7%). Eleven (8.1%) patients died within 2 months after LT, and two deaths were related to Gram-negative infection. Gram-negative bacteria were relatively sensitive to tigecycline and polymyxin B, with resistance of 26.7 and 11.1%, respectively. CRO had lower resistance to ceftazidime/ avibactam (45.5%) and polymyxin B (10%). A univariate analysis showed that male sex, infection within 2 months prior to LT, duration of surgery C 400 min, reoperation, indwelling urethral catheter use C 3 days and elevated alanine aminotransferase on day 1 post-LT were associated with Gram-negative infection. Multivariate logistic regression analysis revealed that infection within 2 months prior to LT [odds ratio (OR) = 4.426, 95%CI: 1.634-11.99, P = 0.003], duration of surgery C 400 min

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Carbapenem-resistant Acinetobacter baumannii Bacteremia in Liver Transplant Recipients

Cited by 19 publications

References 17 publications

Therapeutic Drug Monitoring of Meropenem and Piperacillin in Critical Illness—Experience and Recommendations from One Year in Routine Clinical Practice

Therapeutic Drug Monitoring of Meropenem and Piperacillin in Critical Illness—Experience and Recommendations from One Year in Routine Clinical Practice

Incidence, mortality, and risk factors associated with carbapenem‐resistant Acinetobacter baumannii bacteremia within 30 days after liver transplantation

Drug Resistance and Risk Factors for Acquisition of Gram-Negative Bacteria and Carbapenem-Resistant Organisms Among Liver Transplant Recipients

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