Clinical outcomes of intestinal transplant recipients colonized with multidrug-resistant organisms: a retrospective study

Simkins, Jacques; Morris, Michele; Camargo, José F.; Vianna, Rodrigo; Beduschi, Thiago; Abbo, Lilian M.

doi:10.1111/tri.12987

Cited by 16 publications

(13 citation statements)

References 11 publications

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“…Simkins et al evaluated whether the number of hospitalization days and one‐year post‐transplant survival differed in MDRO‐colonized patients. Although there was no difference in one‐year survival between MDRO‐colonized and non‐colonized patients, survival was lower among MDRO‐colonized patients who developed VRE, carbapenem‐resistant Gram‐negative bacteria, or MRSA bacteremia 29 . Although our study lacks colonization data, our results were similar to Simkins et al, as most of the infections were due to VRE, ESBL producers, and multi‐drug resistant Pseudomonas and Klebsiella species.…”

Section: Discussionsupporting

confidence: 81%

Multidrug-resistant organisms: A significant cause of severe sepsis in pediatric intestinal and multi-visceral transplantation

Alcamo

Trivedi

Dulabon

et al. 2022

American Journal of Transplantation

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Severe sepsis in immunocompromised children is associated with increased mortality. This paper describes the epidemiology landscape, clinical acuity, and outcomes for severe sepsis in pediatric intestinal (ITx) and multi‐visceral (MVTx) transplant recipients requiring admission to the pediatric intensive care unit (PICU). Severe sepsis episodes were retrospectively reviewed in 51 ITx and MVTx patients receiving organs between 2009 and 2015. Twenty‐nine (56.8%) patients had at least one sepsis episode (total of 63 episodes) through December 2016. Bacterial etiologies accounted for 66.7% of all episodes (n = 42), occurring a median of 122.5 days following transplant (IQR 59–211.8 days). Multidrug‐resistant organisms (MDROs) accounted for 73.8% of bacterial infections; extended spectrum beta‐lactamase producers, vancomycin‐resistant enterococcus, and highly‐resistant Pseudomonas aeruginosa were the most commonly identified. Increased mechanical ventilation and vasoactive requirements were noted in MDRO episodes (OR 3.03, 95% CI 1.09–8.46 and OR 3.07, 95% CI 1.09–8.61, respectively; p < .05) compared to non‐MDRO episodes. PICU length of stay was significantly increased for MDRO episodes (7 vs. 3 days, p = .02). Graft loss was 24.1% (n = 7) and mortality was 24.1% (n = 7) in patients who experienced severe sepsis. Further attention is needed for MDRO risk mitigation and modification of sepsis treatment guidelines to ensure MDRO coverage for this population.

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Section: Discussionsupporting

confidence: 81%

Multidrug-resistant organisms: A significant cause of severe sepsis in pediatric intestinal and multi-visceral transplantation

Alcamo

Trivedi

Dulabon

et al. 2022

American Journal of Transplantation

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“…There were no cases of VRE colonization in our small bowel and multivisceral transplants during the peritransplant time period, though there were a limited number of these performed at our center. It is difficult to compare this peritransplantation rate to the only literature report of 50% colonization at 1 year 8 …”

Section: Discussionmentioning

confidence: 86%

“…Vancomycin‐resistant enterococci (VRE) have emerged as an important cause of nosocomial colonization and infection, particularly in high‐risk populations such as solid organ transplant (SOT) patients and those with hematologic malignancies 1–4 . Hospitalization, invasive procedures, and antibiotic use are the main risk factors associated with VRE acquisition in organ transplant patients and the general population 5–9 …”

Section: Introductionmentioning

confidence: 99%

Clinical impact of vancomycin‐resistant enterococci colonization in nonliver solid organ transplantation and its implications for infection control strategies: A single‐center, 10‐year retrospective study

McFarlane

Kabbani

Bakal

et al. 2021

Transplant Infectious Dis

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Background Vancomycin‐resistant enterococci (VRE) colonization in nonliver solid organ transplantation (SOT) is poorly defined. Infection control management of these patients is influenced by the association of VRE with adverse outcomes in liver transplantation. This study examines the frequency and clinical impact of VRE colonization specifically on nonliver SOT patients and discusses implications for nosocomial VRE control. Methods We retrospectively reviewed all nonliver SOT patients at a single transplant center from 2005 to 2015. We determined colonization rates in the peritransplant period and the rate of VRE infections. The association between VRE colonization with 90‐day mortality and other clinical outcomes was examined. Results There were 1786 nonliver SOTs from 2005 to 2015, with 81 (4.6%) colonized with VRE in the peritransplantation period. The colonization prevalence varied by organ type: 45 of 423 lung (10.6%), 12 of 352 heart (3.4%), one of 18 heart–lung (5.6%), 20 of 884 kidney (2.3%), three of 63 kidney–pancreas (4.8%), zero of 11 pancreas, zero of five small bowel, and zero of 11 multivisceral. Peritransplant VRE colonization was not associated with 90‐day mortality odds ratio = 2.35 (95% CI = 0.53, 10.29) and adjusted odds ratio = 1.52 (95% CI = 0.34, 6.88). In the multivariable logistic regression, there was no association with mortality at 1 year or 5 years, hospital length of stay, rehospitalization, or days alive out of hospital. There were 14 inpatient VRE infections up to 1 year after transplantation. Conclusion Nonliver SOT patients have lower rates of VRE colonization than liver SOT, and colonization was not associated with increased adverse clinical outcomes. Although infection control strategies for VRE in hospital remain controversial, nonliver SOT should be considered among typical hospitalized patients when designing strategies for prevention.

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“…Colonization itself did not influence survival, but those who developed bacteremia had worse survival. 14 This further highlights the prevalence of drug-resistant organisms in this population and need for appropriate empiric antibiotic selection and antibiotic stewardship to prevent selection of drug-resistant microorganisms.…”

Section: Discussionmentioning

confidence: 99%

Bloodstream infections among intestinal and multivisceral transplant recipients

Spence

Novick

Natarajan

et al. 2021

Transplant Infectious Dis

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Objective: To examine the etiologies, risk factors, and microbiology of bloodstream infections (BSIs) among intestinal and multivisceral transplant recipients in the 2-year post-operative period. Methods: A retrospective medical record review of adult intestinal or multivisceral transplant recipients between 2003 and 2015. Descriptive statistics were used to describe cohort data. Logistic regression was used to assess factors related to BSIs using a backward selection process. Results: One-hundred and six intestinal or multivisceral transplants were performed in 103 individuals. Fifty-eight percent (n = 62) developed a BSI in the 2-year postoperative period with a median time to first BSI of 53 days (interquartile range [IQR] 15, 169). The majority of BSIs were catheter related 38% (n = 58) when the source was known. Common microbiological isolates included enterococcus 20% (n = 36/174), coagulase-negative staphylococcus 14% (n = 23), and 12% Klebsiella spp (n = 21).Forty-seven percent (n = 17) of the enterococci were resistant to vancomycin, and 14% (n = 10/70) of the gram negatives were extended spectrum beta-lactamase (ESBL) producers. In adjusted analyses, (OR: 0.200 95% CI: 0.2, 0.514, P = .009) men were less likely to have a BSI. Transplant recipient age, allograft type, comorbidities, rejection, and length of stay were not noted to be risk factors for development of BSIs in our cohort. Mortality at 2-years post-transplant was similar for those who did not develop a BSI and those that developed infection, P = .5028. Conclusions:BSIs are a common complication of intestinal transplantation, and central venous catheters were a common source. Interventions such as early catheter removal should be implemented to prevent infections in this population. Female sex association with BSI requires further investigation.

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Clinical outcomes of intestinal transplant recipients colonized with multidrug-resistant organisms: a retrospective study

Cited by 16 publications

References 11 publications

Multidrug-resistant organisms: A significant cause of severe sepsis in pediatric intestinal and multi-visceral transplantation

Multidrug-resistant organisms: A significant cause of severe sepsis in pediatric intestinal and multi-visceral transplantation

Clinical impact of vancomycin‐resistant enterococci colonization in nonliver solid organ transplantation and its implications for infection control strategies: A single‐center, 10‐year retrospective study

Bloodstream infections among intestinal and multivisceral transplant recipients

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