Deceased donors with multidrug-resistant organisms: implications and future directions

Pouch, Stephanie M.; Ison, Michael G.

doi:10.1097/mot.0000000000000991

Cited by 4 publications

(1 citation statement)

References 39 publications

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“…Although the epidemiology varies markedly among different geographical regions, risk factors of prolonged (> 7 days) ICU stay, vasopressor support, and cardiopulmonary resuscitation increases colonization with multidrug-resistant organisms (MDRO) including extended-spectrum β-lactamase -producing Enterobacteriaceae (ESBL-E) and carbapenem-resistant organisms (CRO) in donors [ 4 ]. The current study suggests that MDRO or CRO may significantly contribute to the burden of bacterial DDI [ 5 , 6 ]. Lung transplant recipients appear to be disproportionately affected, potentially due to the high frequency of MDRO colonization of the donor respiratory tract [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Real-time, random-access organ screening for carbapenem-resistant organisms (CRO) reduces CRO-associated, donor-derived infection mortality in lung transplant recipients

Zhou,

Shen,

Shi

et al. 2023

Infection

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Purpose Donor-derived infection (DDI) has become an important factor affecting the prognosis of lung transplantation patients. The risks versus benefits of using donor organs infected with multidrug-resistant organisms (MDRO), especially carbapenem-resistant organisms (CRO), are frequently debated. Traditional microbial culture and antimicrobial susceptibility testing at present fail to meet the needs of quick CRO determination for donor lungs before acquisition. In this study, we explored a novel screening method by using Xpert® Carba-R assay for CRO in donor lungs in a real-time manner to reduce CRO-associated DDI mortality. Methods This study was registered on chictr.org.cn (ChiCTR2100053687) on November 2021. In the Xpert Carba-R screening group, donor lungs were screened for CRO infection by the Xpert Carba-R test on bronchoalveolar fluid (BALF) before acquisition. If the result was negative, donor lung acquisition and subsequent lung transplantation were performed. In the thirty-five potential donors, nine (25.71%) with positive Xpert Carba-R results in BALF were declined for lung transplantation. Twenty-six recipients and the matching CRO-negative donor lungs (74.29%) were included in the Xpert Carba-R screening group. In the control group, nineteen recipients underwent lung transplants without Xpert Carba-R screening. The incidence and mortality of CRO-associated DDI were collected and contrasted between the two groups. Results Multivariate analysis showed that CRO-related death due to DDI within 60 days was significantly lower in the Xpert Carba-R screening group than that in the control group (OR = 0.05, 95% CI 0.003–0.74, p = 0.03). Conclusion Real-time CRO screening of donor lungs before transplantation at the point of care by the Xpert Carba-R helps clinicians formulate lung transplantation strategies quickly and reduces the risk of subsequent CRO infection improving the prognosis of lung transplantation.

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Section: Introductionmentioning

confidence: 99%

Real-time, random-access organ screening for carbapenem-resistant organisms (CRO) reduces CRO-associated, donor-derived infection mortality in lung transplant recipients

Zhou,

Shen,

Shi

et al. 2023

Infection

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Donor-derived carbapenem-resistant gram-negative bacterial infections in solid organ transplant recipients: Active surveillance enhances recipient safety

Mularoni,

Cona,

Campanella

et al. 2024

American Journal of Transplantation

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Non-Standard Risk Donors and Risk of Donor-Derived Infections: From Evaluation to Therapeutic Management

Grossi,

Wolfe,

Peghin

2024

Transpl Int

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Expected and unexpected donor-derived infections are a rare complication of solid organ transplantation, but can result in significant morbidity and mortality. Over the last years, the growing gap existing between patients on the waiting list and available organs has favored the use of organs from donors with suspected or confirmed infections, thanks to the improvement of risk mitigation strategies against transmission of well recognized and emerging infections. Given the recent developments, the particular interest of this review is to summarize data on how to maximize utilization of HIV+ donors in HIV+ recipients, the use of HCV-viremic donors and HBV positive donors. This article also covers the implications for recipient of organs from donors with bacteremia and the challenge of multidrug resistant (MDR) infections. Lastly this review describes emerging risks associated with recent Coronavirus Disease-2019 (COVID-19) pandemics.

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Deceased donors with multidrug-resistant organisms: implications and future directions

Cited by 4 publications

References 39 publications

Real-time, random-access organ screening for carbapenem-resistant organisms (CRO) reduces CRO-associated, donor-derived infection mortality in lung transplant recipients

Real-time, random-access organ screening for carbapenem-resistant organisms (CRO) reduces CRO-associated, donor-derived infection mortality in lung transplant recipients

Donor-derived carbapenem-resistant gram-negative bacterial infections in solid organ transplant recipients: Active surveillance enhances recipient safety

Non-Standard Risk Donors and Risk of Donor-Derived Infections: From Evaluation to Therapeutic Management

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