The influence of carbapenem resistance on mortality in solid organ transplant recipients with Acinetobacter baumanniiinfection

Gouvêa, Érika Ferraz de; Martins, Ianick Souto; Halpern, Márcia; Ferreira, A.; Basto, Samanta Teixeira; Gonçalves, Renato Torres; Moreira, Beatriz Meurer; Santoro‐Lopes, Guilherme

doi:10.1186/1471-2334-12-351

Cited by 47 publications

(44 citation statements)

References 20 publications

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“…Acute kidney injury can also be seen in LT recipients with severe preoperative hepatic impairment. In 2012, de Gouvêa et al (10) reported that hemodialysis after SOT is more common among recipients who evolve to infection with CRAB than among those who develop infection with carbapenemsusceptible A. baumannii.…”

Section: Discussionmentioning

confidence: 99%

“…(8) Although the most often cited primary site of CRAB infection is the respiratory tract, some studies have shown that the abdominal cavity is the most common primary site of such infections among LT recipients. (6,7,9,10) Although there have been a number of case series investigating CRAB infection among LT recipients, the risk factors for CRAB colonization and infection after LT remain poorly defined in the literature. In addition, certain important aspects, such as the impact that pretransplant CRAB colonization or infection has on the incidence of posttransplant CRAB infection and survival among LT recipients, have not been evaluated.…”

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confidence: 99%

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Carbapenem‐resistant A cinetobacter baumannii acquired before liver transplantation: Impact on recipient outcomes

et al. 2016

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Infection with carbapenem-resistant Acinetobacter baumannii (CRAB) after liver transplantation (LT) is associated with high mortality. This study aimed to identify risk factors for post-LT CRAB infection, as well as to evaluate the impact of pre-LT CRAB acquisition on the incidence of post-LT CRAB infection. This was a prospective cohort study of all patients undergoing LT at our facility between October 2009 and October 2011. Surveillance cultures (SCs) were collected immediately before LT and weekly thereafter, until discharge. We analyzed 196 patients who were submitted to 222 LTs. CRAB was identified in 105 (53.6%); 24 (22.9%) of these patients were found to have acquired CRAB before LT, and 85 (81.0%) tested positive on SCs. Post-LT CRAB infection occurred in 56 (28.6%), the most common site being the surgical wound. Multivariate analysis showed that the risk factors for developing CRAB infection were prolonged cold ischemia, post-LT dialysis, LT due to fulminant hepatitis, and pre-LT CRAB acquisition with pre-LT CRAB acquisition showing a considerable trend toward significance (P = 0.06). Among the recipients with CRAB infection, 60-day mortality was 46.4%, significantly higher than among those without (P < 0.001). Mortality risk factors were post-LT infection with multidrug-resistant bacteria, LT performed because of fulminant hepatitis, retransplantation, prolonged cold ischemia, longer LT surgical time, and pre-LT CRAB acquisition, the last showing a trend toward significance (P = 0.08). In conclusion, pre-LT CRAB acquisition appears to increase the risk of post-LT CRAB infection, which has a negative impact on recipient survival. Liver Transplantation 22 615-626 2016 AASLD.

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Section: Discussionmentioning

confidence: 99%

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Carbapenem‐resistant A cinetobacter baumannii acquired before liver transplantation: Impact on recipient outcomes

et al. 2016

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“…Some studies have reported a high frequency of infection caused by MDR organisms in solid organ recipients, ranging from 6.5% to 56% (4,5,7,9,11,(25)(26)(27)(28)(29)(30)(31). In this regard, intense immunosuppressive therapy could leave immunocompromised patients more susceptible to infections caused by MDR organisms.…”

Section: Discussionmentioning

confidence: 99%

“…Few antibiotics are available to treat infections caused by these pathogens, and those that can be prescribed are mostly for parenteral administration and carry a higher risk of adverse effects. Moreover, infections caused by MDR rods are often associated with worse outcomes (7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Impact of Antibiotic Resistance on the Development of Recurrent and Relapsing Symptomatic Urinary Tract Infection in Kidney Recipients

Bodro¹,

Sanclemente²,

Lipperheide³

et al. 2015

American Journal of Transplantation

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(abstract #1302).We sought to determine the frequency, risk factors, and clinical impact of recurrent urinary tract infections (UTI) in kidney transplant recipients. Of 867 patients who received a kidney transplant between 2003 and 2010, 174 (20%) presented at least one episode of UTI. Fifty-five patients presented a recurrent UTI (32%) and 78% of them could be also considered relapsing episodes. Recurrent UTI was caused by extended-spectrum betalactamase (ESBL)-producing Klebsiella pneumoniae (31%), followed by non-ESBL producing Escherichia coli (15%), multidrug-resistant (MDR) Pseudomonas aeruginosa (14%), and ESBL-producing E. coli (13%). The variables associated with a higher risk of recurrent UTI were a first or second episode of infection by MDR bacteria (OR 12; 95%CI 528), age >60 years (OR 2.2; 95%CI 1.15.1), and reoperation (OR 3; 95%CI 1.37.1). In addition, more relapses were recorded in patients with UTI caused by MDR organisms than in those with susceptible microorganisms. There were no differences in acute rejection, graft function, graft loss or 1 year mortality between groups. In conclusion, recurrent UTI is frequent among kidney recipients and associated with MDR organism. Classic risk factors for UTI (female gender and diabetes) are absent in kidney recipients, thus highlighting the relevance of uropathogens in this population.

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“…In prior studies that rigorously controlled for severity of illness, A. baumannii infection was not independently associated with increased mortality, raising the possibility that this organism is a marker of increased severe underlying illness rather than an independent predictor of mortality. (5,6) In the current study, nearly 30% of infected patients (16/56) died within 24 hours of diagnosis despite reportedly being on effective Abbreviations: CRAB, carbapenem-resistant Acinetobacter baumannii; CRKP, carbapenem-resistant Klebsiella pneumoniae; LT, liver transplantation; MDR, multidrug resistant; PFGE, pulsed-field gel electrophoresis.Address reprint requests to …”

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The evolving threat of carbapenem‐resistant infections after liver transplantation: The case of A cinetobacter baumannii

Pereira

Uhlemann

2016

Liver Transpl

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Postoperative bacterial infections have shifted from predominantly gram-positive to gram-negative organisms in liver transplantation (LT) recipients.(1) Of concern is the increasing incidence of difficult to treat multidrug resistant (MDR) infections due to extended spectrum b-lactamases and carbapenemresistant Enterobacteriacae. The high mortality rate (40%-70%) associated with post-LT carbapenemresistant Klebsiella pneumoniae (CRKP) infections is a sobering example of the impact of MDR infection in this population. (2,3) In this issue of Liver Transplantation, Freire et al. (4) provide compelling evidence that an additional organism, carbapenem-resistant Acinetobacter baumannii (CRAB), is also associated with very high morbidity and mortality after LT. In a prospective 2-year cohort study, the authors routinely surveyed colonization with A. baumannii at 3 body sites (rectum, throat, and axilla) immediately prior to LT and weekly thereafter until hospital discharge. Of the 196 LT recipients evaluated, 105 (54%) were found to have acquired CRAB, most often (n 5 81) during the post-LT period. Similarly, although 60 recipients developed CRAB infection, the majority of these (n 5 56) occurred post-LT and usually early in the post-LT course (median time, 9 days; range, 1-43 days). The likelihood of post-LT CRAB acquisition increased with retransplantation within 60 days after LT and prior use of piperacillintazobactam or a carbapenem. Most notably, 60-day mortality in the recipients with CRAB infection was 46.4%. Risk factors associated with 60-day mortality included LT for acute liver failure, need for post-LT dialysis, prolonged cold ischemia time, and a trend toward significance for pre-LT CRAB acquisition. Molecular typing by pulsed-field gel electrophoresis (PFGE) analysis revealed that 71% of infected recipients had 1 predominant strain, suggesting a clonal outbreak in the LT unit or across the hospital. Importantly, a series of infection control measures including weekly surveillance cultures, contact precautions, contact isolation of CRAB-colonized patients, hand hygiene training, and systematic discussions of CRAB cases attributed to the unit resulted in the incidence of CRAB acquisition dropping from 12.2/1000 patient-days in 2009 to 5.5/1000 patient-days by 2014.Although these findings are remarkable, some aspects of the conclusions should be interpreted with caution. For instance, this study was performed during an outbreak, perhaps limiting its applicability. It also remains unclear if this was solely an outbreak in the LT unit or represented a hospital-wide outbreak. In addition, although the crude 60-day mortality was very high, determining the attributable mortality of post-LT CRAB infections is difficult. In prior studies that rigorously controlled for severity of illness, A. baumannii infection was not independently associated with increased mortality, raising the possibility that this organism is a marker of increased severe underlying illness rather than an independent predictor of mortality. (5,...

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The influence of carbapenem resistance on mortality in solid organ transplant recipients with Acinetobacter baumanniiinfection

Cited by 47 publications

References 20 publications

Carbapenem‐resistant A cinetobacter baumannii acquired before liver transplantation: Impact on recipient outcomes

Carbapenem‐resistant A cinetobacter baumannii acquired before liver transplantation: Impact on recipient outcomes

Impact of Antibiotic Resistance on the Development of Recurrent and Relapsing Symptomatic Urinary Tract Infection in Kidney Recipients

The evolving threat of carbapenem‐resistant infections after liver transplantation: The case of A cinetobacter baumannii

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