<p>Risk Factors and Outcomes of Carbapenem-Resistant Enterobacteriaceae Infection After Liver Transplantation: A Retrospective Study in a Chinese Population</p>

Abstract

Background There is an increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE) infection after liver transplantation (LT). Improved understanding of the risk factors and outcomes of CRE infections can help us to develop effective preventive strategies and even guide early treatment of high-risk LT patients. Methods This was a retrospective study involving all Chinese adult patients who underwent LT between December 2017 and September 2019 in our center. We analyzed the possible risk factors and outcomes associated with CRE infections in the first 30 days post-LT. Results A total of 387 patients underwent LT. Among them, 26 patients (6.7%) developed CRE infections within 30 days after transplantation. Patients with CRE infections had significantly lower 30-day and 180-day survival rates (80.8% vs 96.4%, p <0.001; 51.5% vs 92.4%, p <0.001). Multivariate analysis identified that intraoperative blood loss equal to or more than 1500 mL (odds ratio [OR], 3.666; 95% confidence interval [CI], 1.407–9.550; p =0.008), CRE rectal carriage within 30 days post-LT (OR, 5.516; 95% CI, 2.113–14.399; p =0.000), biliary complications (OR, 3.779; 95% CI, 1.033–13.831; p =0.045) and renal replacement therapy for more than 3 days (OR, 3.762; 95% CI, 1.196–11.833; p =0.023) were independent risk factors for CRE infections within 30 days post-LT. Conclusion CRE infections within 30 days post-LT were associated with worse outcomes. Intraoperative blood loss equal to or more than 1500 mL, CRE rectal carriage within 30 days post-LT, biliary complications and renal replacement therapy for more than 3 days were independent risk factors of CRE infections after LT.

The Prognostic Factors of Bloodstream Infection in Immunosuppressed Elderly Patients: A Retrospective, Single-center, Five-year Cohort Study

“…Previous studies also showed that the infectious site was more prone to biliary duct infection in solid organ transplantation and biliary complication was the prognostic risk factor of carbapenem-resistant Enterobacteriaceae infection after liver transplantation. 28 , 29 Our study acquired the similar conclusion. In our study, the biliary infection could be an independent prognostic risk factor of 90-day death for immunosuppressed elderly people (OR: 4.406, 95%CI: 1.794–10.821, p =0.001).…”

Carbapenems versus Cephalosporin or Piperacillin-Tazobactam as Perioperative Antibiotic Prophylaxis in Liver Transplant Recipients with Model for End-Stage Liver Disease Scores of ≥30: A Retrospective Study in a Chinese Population

“… 21–23 In our previous study, the incidence of CRE infection was 6.7% within 30 days after LT, and patients with CRE infections had significantly lower 180-day survival rates (51.5% vs 92.4%, p < 0.001). 24 Since the use of carbapenems is associated with an increased risk of CRO infection, we analyzed the incidence of CRO infection in this study. 25 We found that 13.3% of patients developed CRO infections within 30 days after LT. And, the CRO infection rate did not differ significantly between the carbapenem and non-carbapenem groups.…”

Cefiderocol, a Siderophore Cephalosporin, as a Treatment Option for Infections Caused by Carbapenem-Resistant Enterobacterales

“…Risk factors for CRE colonisation and/or infection are similar to those identified for all CR Gram-negative infections [10], being associated with the host (e.g., older age), hospitalisation (e.g., number of previous hospitalisations, emergency department stay[2 days prior to intensive care unit admission), treatment (e.g., previous exposure to antibiotics) and procedures (e.g., invasive procedures/indwelling devices), recent surgery, immunocompromised status and organ transplantation [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25], chronic skin ulcers [13], along with mechanical ventilation and patient movement between hospital departments [26].…”