Colonization with multidrug-resistant organisms is associated with in increased mortality in liver transplant candidates

Abstract

Objectives Rising prevalence of multidrug-resistant organisms (MDRO) is a major health problem in patients with liver cirrhosis. The impact of MDRO colonization in liver transplantation (LT) candidates and recipients on mortality has not been determined in detail. Methods Patients consecutively evaluated and listed for LT in a tertiary German liver transplant center from 2008 to 2018 underwent screening for MDRO colonization including methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant gram-negative bacteria (MDRGN), and vancomycin-resistant enterococci (VRE). MDRO colonization and infection status were obtained at LT evaluation, planned and unplanned hospitalization, three months upon graft allocation, or at last follow-up on the waiting list. Results In total, 351 patients were listed for LT, of whom 164 (47%) underwent LT after a median of 249 (range 0–1662) days. Incidence of MDRO colonization increased during waiting time for LT, and MRDO colonization was associated with increased mortality on the waiting list (HR = 2.57, p<0.0001. One patients was colonized with a carbapenem-resistant strain at listing, 9 patients acquired carbapenem-resistant gram-negative bacteria (CRGN) on the waiting list, and 4 more after LT. In total, 10 of these 14 patients died. Conclusions Colonization with MDRO is associated with increased mortality on the waiting list, but not in short-term follow-up after LT. Moreover, colonization with CRGN seems associated with high mortality in liver transplant candidates and recipients.

Molecular Surveillance of Carbapenem-Resistant Gram-Negative Bacteria in Liver Transplant Candidates

“…From 2008 to 2018, 351 patients evaluated and listed for LT had undergone MDRO screening according to the in-house hygiene plan ( Ferstl et al, 2021 ). Among these 351 patients, 24 CRGN were identified in 23 patients, including one patient with the detection of two CRGN ( K. pneumoniae and P. aeruginosa ).…”

“…(ii) CR can be acquired by so-called “plasmid hospitalism” which might be the result of a horizontal interspecies gene transfer ( Göttig et al, 2015 ) and, (iii), maybe most important, CRGN can be transmitted directly from patient to patient via , for example, shortcomings in infection control measures. Here, we report on the WGS analysis of 18 CRGN isolates obtained from 24 detected CRGN isolates (from 23 patients) while screening of 351 patients evaluated for liver transplantation ( Ferstl et al, 2021 ) over a period of 10years.…”

High Acquisition Rate of Gram-Negative Multi-Drug Resistant Organism Colonization During Hospitalization: A Perspective from a High Endemic Setting

“… 25 Being colonized with extended spectrum β–lactamase E. coli increases the risk of infections such as blood stream infection and reversely, underlying disease increases the risk of acquisition of E. coli . 26 , 27 Therefore it is important to take an organism-specific approach in the participating hospital including active screening of these organisms on admission. 5 , 6 Concerningly A. baumannii was detected in polytrauma and bone and joints unit and patients admitting to these facilities should be prioritized for screening.…”

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“…Colonization with CRGN is associated with repeated hospitalization, sepsis, and increased mortality in patients with advanced liver disease (Ferstl et al, 2017(Ferstl et al, , 2021. Therefore, it is of utmost importance to avoid transmission of CRGN to patients that are awaiting or underwent LT.…”

“…(ii) CR can be acquired by so-called "plasmid hospitalism" which might be the result of a horizontal interspecies gene transfer (Göttig et al, 2015) and, (iii), maybe most important, CRGN can be transmitted directly from patient to patient via, for example, shortcomings in infection control measures. Here, we report on the WGS analysis of 18 CRGN isolates obtained from 24 detected CRGN isolates (from 23 patients) while screening of 351 patients evaluated for liver transplantation (Ferstl et al, 2021) over a period of 10 years.…”