Colonization and Infection With Extensively Drug Resistant Gram-Negative Bacteria in Liver Transplant Recipients

E Massa; E Michailidou; D Agapakis; S Papadopoulos; T Tholioti; I Aleuroudis; T Bargiota; M Passakiotou; M Daoudaki; N Antoniadis; G Imvrios; E Iosifidis; E Vagdatli; E Roilides; D Vasilakos; I Fouzas; E Mouloudi

doi:10.1016/j.transproceed.2019.01.076

Colonization and Infection With Extensively Drug Resistant Gram-Negative Bacteria in Liver Transplant Recipients

Transplant Proc. 2019 Mar;51(2):454-456. doi: 10.1016/j.transproceed.2019.01.076. Epub 2019 Jan 28.

Authors

E Massa¹, E Michailidou², D Agapakis², S Papadopoulos², T Tholioti², I Aleuroudis², T Bargiota², M Passakiotou², M Daoudaki³, N Antoniadis³, G Imvrios³, E Iosifidis⁴, E Vagdatli⁵, E Roilides⁴, D Vasilakos⁶, I Fouzas³, E Mouloudi²

Affiliations

¹ Intensive Care Unit, Hippokratio General Hospital, Thessaloniki, Greece. Electronic address: elenizioga@yahoo.com.
² Intensive Care Unit, Hippokratio General Hospital, Thessaloniki, Greece.
³ Division of Transplantation, Department of Surgery, Hippokratio General Hospital, Medical School Aristotle University of Thessaloniki, Thessaloniki, Greece.
⁴ Infectious Diseases Section, 3rd Department of Pediatrics, Hippokratio General Hospital, Medical School Aristotle University of Thessaloniki, Thessaloniki, Greece.
⁵ Biopathology Laboratory Unit Hippokratio General Hospital, Thessaloniki, Greece.
⁶ Anesthesiology Department University Hospital "AHEPA" Medical School Aristotle University of Thessaloniki, Thessaloniki, Greece.

PMID: 30879565
DOI: 10.1016/j.transproceed.2019.01.076

Abstract

Background: Infections due to extensively drug resistant Gram-negative bacteria (GNB) after solid organ transplantation are increasing in prevalence and are associated with high morbidity and mortality. Surveillance culture (SC) seems to be an important tool for extensively drug resistant GNB control. The aim of this study was to evaluate colonization rates and subsequent infections by XDR-GNB in liver transplant recipients.

Material and methods: This was a prospective cohort study in patients who underwent liver transplantation (LT) between January 2016 and January 2018. Data on demographics, extensively drug resistant colonization, and 3-month clinical outcomes were obtained. Colonization was defined as a positive surveillance culture (SC-perirectal) immediately before transplantation, once weekly after LT, and after intensive care unit discharge, with emphasis to carbapenem-resistant Gram-negative bacteria (CR-GNB).

Results: Forty-four patients who underwent LT were included in the study. Ten patients (22.72%) were colonized with CR-GNB prior to transplantation, and 7/10 (70%) developed infection due to the same pathogen (5 patients bloodstream infections, 2 patients pneumonia) during the study period. Intensive care unit length of stay was significantly longer in colonized with CR-GNB patients (P < .05). Mortality rate was higher in colonized patients (30%) than in noncolonized (11.76%) (P = .2).

Conclusion: Our study results suggest an overall 70% risk of CR-GNB infection among colonized patients. Given the high mortality rate and the difficulty in treating these infections, further research to investigate and develop strategies to eliminate the colonization is needed.

MeSH terms

Adult
Aged
Drug Resistance, Bacterial
Female
Gram-Negative Bacterial Infections / epidemiology*
Gram-Negative Bacterial Infections / immunology*
Humans
Immunocompromised Host*
Liver Transplantation*
Male
Middle Aged
Prevalence
Prospective Studies
Risk Factors