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Evolving trends in multiple‐antibiotic–resistant bacteria in liver transplant recipients: A longitudinal study of antimicrobial susceptibility patterns
Author(s) -
Singh Nina,
Gayowski Timothy,
Rihs John D.,
Wagener Marilyn M.,
Marino Ignazio R.
Publication year - 2001
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1053/jlts.2001.20769
Subject(s) - medicine , liver transplantation , antimicrobial , antibiotics , antibiotic resistance , bacteria , microbiology and biotechnology , transplantation , biology , genetics
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‐antibiotic‐resistant 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 β‐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.