Epidemiology, Susceptibility, and Risk Factors Associated with Mortality in Carbapenem-Resistant Gram-Negative Bacterial Infections Among Abdominal Solid Organ Transplant Recipients: A Retrospective Cohort Study

Abstract

Introduction Carbapenem-resistant gram-negative bacteria (CR-GNB) can cause life-threatening infections among abdominal solid organ transplantation (ASOT) recipients. This study aimed to investigate the epidemiology and drug susceptibility of CR-GNB pathogens and identity the risk factors associated with 90-day crude mortality of CR-GNB infections among ASOT recipients. Methods We retrospectively reviewed the clinical characteristics, drug resistance rate, and risk factors associated with mortality in CR-GNB infections among ASOT recipients between August 1, 2013, and August 1, 2020. The Cox regression model was performed to identify the independent risk factors for mortality. Results During the 8-year period, CR-GNB infections occurred in 153 of 1452 (10.5%) recipients, and 23 of 153 (15.0%) patients died. The most common pathogen was Acinetobacter baumannii ( n = 47). The drug resistance rate of CR-GNB pathogens was relatively low to tigecycline (33.3%) and high to other categories (> 60%). There was a significant increasing trend in drug resistance to tigecycline as time went on (from 24 to 40%, P = 0.04). The independent risk factors for mortality were mechanical ventilation (hazard ratio 7.40, 95% confidence interval 2.69–20.38, P < 0.001), septic shock (hazard ratio 7.41, 95% confidence interval 2.86–19.23, P < 0.001), and platelet count < 50,000/mm 3 (hazard ratio 4.00, 95% confidence interval 1.49–10.76, P = 0.006). Conclusion CR-GNB is widespread with high prevalence and mortality rates among ASOT recipients. Mechanical ventilation, septic shock, and low platelet count represent three independent risk factors related to the mortality of ASOT recipients with CR-GNB infection. We suggest that tigecycline may be used under rigorous management because of the significant increasing risk of drug resistance. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00411-z.

Predictors of Mortality and Drug Resistance Among Carbapenem-Resistant Enterobacteriaceae-Infected Pancreatic Necrosis Patients

“…Over the past decade, CRE has caused life-threatening infections with high mortality and economic burden in the global healthcare systems [ 11 , 25 ]. AP patients, especially those complicated with IPN, are vulnerable to many potential risk factors associated with acquisition of MDR bacterial or CRE infections, such as overuse of prophylactic antibiotics, longer length of hospitalizations and anti-inflammatory conditions [ 3 , 9 , 14 ].…”

“…Referrals were defined as patients transferred from lower-level hospitals 48 h after the AP occurred. Isolations of CRE were defined as positive specimens obtained from blood, bronchoalveolar fluid, bile and the first drainage of the IPN [ 11 ]. For anti-infective therapy, we recorded the antibiotic treatment at the initial choice (3–5 days).…”

“…Drug susceptibility and minimum inhibitory concentration were determined and measured by Kerby-Bauer disk diffusion and agar dilution, respectively. All the antimicrobial reagents were products of Oxoid Ltd. Carbapenem-resistance was defined as acquired nonsusceptibility to meropenem or imipenem (minimal inhibitory concentration ≥ 2 mg/l) [ 11 ]. Drug resistances of polymyxin and ceftazidime-avibactam were not described, because our hospitals did not perform the drug resistance tests of these two antibiotics until 2020 and most patients in our cohort did not take this test.…”

“…The Guideline of the American College of Gastroenterology supports the use of carbapenems in AP patients for infected pancreatic necrosis (IPN) based on the microbiologic profile and necrotic tissue penetration ability [ 10 ]. However, with the indiscriminate use of carbapenems, carbapenem-resistant Enterobacteriaceae (CRE), one of the most dangerous pathogens, has emerged as a serious global threat to hospitalization patients with limited therapeutic options and a high mortality rate [ 11 ]. Overused prophylactic antibiotic treatments for ‘suspected’ IPN could result in the acquisition of MDR or carbapenem resistance [ 1 ].…”

“…SD standard deviation, AP acute pancreatitis, ARDS acute respiratory distress syndrome, SOFA Sequential Organ Failure Assessment, IPN infected pancreatic necrosis, PCD percutaneous catheter drainage, ETD endoscopic transluminal drainage, OPN open necrosectomy * P values are statistically significant between survival and mortality groups resistant than the total. On the other hand, resistance rates of K. pneumoniae were higher than the total.DISCUSSIONOver the past decade, CRE has caused lifethreatening infections with high mortality and economic burden in the global healthcare systems[11,25]. AP patients, especially those complicated with IPN, are vulnerable to many potential risk factors associated with acquisition of MDR bacterial or CRE infections, such as…”