Evolving trends in multiple-antibiotic-resistant bacteria in liver transplant recipients: A longitudinal study of antimicrobial susceptibility patterns

Abstract

The incidence, sources, impact on outcome, and temporal trends in multiple-antibiotic-resistant bacteria in liver transplant recipients over the last decade (from 1990 through 1999) were assessed. Of 165 consecutive patients who underwent transplantation, 31% (51 of 165 patients) had at least 1 infection caused by multiple-antibioticresistant bacteria. Overall, 69% (66 of 96 infections) of all bacterial infections were multiple-antibiotic resistant. Ninety-one percent (45 of 49 isolates) of the Staphylococcus aureus isolates, 50% (6 of 12 isolates) of the enterococci, and 54% of the gram-negative bacteria (47%; 7 of 15 Pseudomonas aeruginosa, and 60%; 12 of 20 Enterobacteriaceae) were multiple-antibiotic resistant. A significant trend toward an increase in infections caused by multiple-antibiotic-resistant bacteria (P ‫؍‬ .003), largely caused by an increase in gram-positive infections, was documented through the decade. There was a significant increase in infections caused by methicillin-resistant S aureus (P ‫؍‬ .0001) and vancomycin-resistant enterococci (P ‫؍‬ .04) over time. The proportion of gram-negative isolates that were multiple-antibiotic resistant (P ‫؍‬ .447) did not increase significantly over time. However, a strikingly high frequency of resistance to piperacillin or ceftazidime suggests that extended-spectrum ␤-lactamase production in our Enterobacteriaceae may have been more prevalent than realized. Mortality at 1 year was significantly greater in patients with multiple-antibiotic-resistant bacteria compared with all other patients (P ‫؍‬ .001). These longitudinal trends have implications not only for guiding therapeutic practices, but ultimately for devising strategies to curtail multiple-antibiotic resistance in liver transplant recipients. (Liver Transpl 2001;7:22-26.)

Bacteremia in Lung Transplant Recipients in the Current Era

“…Assessment of trends in the epidemiology of bacterial infections in immunosup-pressed hosts have often focused on bloodstream infections as a benchmark (11,15,19). In liver and heart transplant recipients, the proportion of Gram-negative bacteremias have increased from 43.5% and 57.9% in mid to late 1990s to 52% and 80% respectively, in the current era.…”

“…Bacteremia was considered primary if the offending pathogen was not related to infection at another site or if it was vascular-catheter related (9). The source was considered pulmonary if the same bacteria was also isolated from the pleural fluid or Multiple-antibiotic resistance was defined as enterococci resistant to vancomycin; S. aureus resistant to methicillin; enterobacteriaceae resistant to at least two of the following: extended spectrum penicillins, quinolones, third-generation cephalosporins, or aminoglycosides; and P. aeruginosa or other nonfermenting Gram-negative bacteria resistant to at least two of the following: extended spectrum penicillins, quinolones, generation cephalosporins, aztreonam, carbapenems, or aminoglycosides (11,12). Prior antibiotic use was defined as use of antibiotics for ≥ 1 day within 14 days preceding the onset of bacteremia.…”

Multidrug-resistant Gram-negative bacteria in solid organ transplant recipients with bacteremias

“…Bloodstream infections (BSIs) remain important complications and are associated with significant morbidity and mortality among solid organ transplant (SOT) recipients [1][2][3][4][5][6][7][8][9][10][11]. Mortality due to BSIs ranges from 3 % to 33 % in heart, 10 % to 52 % in liver, 6 % to 25 % in lung, 6 % to 44 % in solitary pancreas or simultaneous kidney-pancreas, and 3 % to 11 % in kidney transplant recipients [2,5,6,[12][13][14][15][16][17][18][19].…”

Prevalence, Molecular Epidemiology, and Clinical Significance of Heterogeneous Glycopeptide-Intermediate Staphylococcus aureus in Liver Transplant Recipients

“…Thus, heterogeneous resistance might be more clinically relevant in patients with a severe underlying condition, patients who have undergone surgery, or patients receiving immunosuppressive therapy, such as liver transplant (LT) recipients. Methicillin-resistant S. aureus (MRSA) is the leading cause of bacterial infection after an LT (2,24,25). No studies have looked at the impact of hGISA in LT recipients.…”