Evaluation of extensively drug-resistant gram-negative bacteremia among solid-organ transplant recipients: a multicenter study

Abstract

Background/aim: The aim of this study is to evaluate the distribution, sources, clinical features, and mortality rates of bacteremia due to evaluation of extensively drug-resistant (XDR) gram negative among solid-organ transplant (SOT) recipients. Materials and methods:A retrospective study of SOT recipients with bacteremia due to XDR gram-negative pathogens in 11 centers between 2016 and 2018 was conducted. Patients' records were evaluated.Results: Of 171 bacteremia that occurred in 164 SOT recipients, 93 (56.7%) were liver, 46 (28%) kidney, 14 (8.5%) heart, and 11 (6.7%) lung recipients. Bacteremia episodes were recorded in the first year in 63.7% of the patients (n = 109), early-onset bacteremia was recorded in 45% (n = 77) of the episodes. In multivariate analysis, catheter-associated bacteremia was an independent risk factor for 7-day mortality (p = 0.037), and early-onset bacteremia was found as an independent risk factor for 30-day mortality (p = 0.017). Conclusion:Difficult-to-treat infections due to XDR bacteria in SOT recipients shadow the success of transplantation. Central venous catheters seem to be the main risk factor. Judicious use of medical devices is of pivotal importance.

Multidrug-resistant organisms in lung transplant: a narrative review

“…The CRE-associated mortality rate in SOT is consistent (up to 70%), as confirmed by The American Society of Transplantation Infectious Diseases Community [ 15 , 29 , 31 , 32 ]. Likewise, Yanik Yalçin et al [ 33 ] confirmed that the above-mentioned mortality rate was even higher in lung transplant recipients with CRE infections. With regards to MDR P. aeruginosa , a pretransplant colonization of the respiratory tract is especially common in lung transplant recipients with cystic fibrosis (CF), with a prevalence of 50% that may increase up to 75% after lung transplant [ 34 ].…”

“…MDR GN bacteria isolation after transplantation is increasing, and no extended data are available regarding infections by XDR and PDR pathogens in lung transplant recipients. Although this, some findings could be extrapolated from previous retrospective studies and one case report [33,[36][37][38].…”

“…MDR GN bacteria isolation after transplantation is increasing, and no extended data are available regarding infections by XDR and PDR pathogens in lung transplant recipients. Although this, some findings could be extrapolated from previous retrospective studies and one case report [33,36–38]. Yanik Yalçin et al [33] enrolling 164 SOT recipients from 11 Turkish hospitals, described 171 episodes of XDR GN bacteraemia, 63.7% of whom within the first year after surgery.…”

“…Yan ˇik Yalc ¸in et al [33] enrolling 164 SOT recipients from 11 Turkish hospitals, described 171 episodes of XDR GN bacteraemia, 63.7% of whom within the first year after surgery. The most common XDR pathogen, identified in one-third of the lung transplant cohort of patients, was K. pneumoniae with a rate of 7-day mortality around 36% [33]. According to these findings, 63.7% of XDR GN bacteria occurred in the first year after transplantation and the highest rate of early-onset bacteraemia was in lung transplant patients [33].…”

“…The most common XDR pathogen, identified in one-third of the lung transplant cohort of patients, was K. pneumoniae with a rate of 7-day mortality around 36% [ 33 ]. According to these findings, 63.7% of XDR GN bacteria occurred in the first year after transplantation and the highest rate of early-onset bacteraemia was in lung transplant patients [ 33 ]. PDR and XDR bacteria in the SOT population are mostly gram-negative pathogens and often occur in lung transplant due to cystic fibrosis [ 36 , 38 , 39 ].…”