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Impact of pre‐transplant carbapenem‐resistant Enterobacterales colonization and/or infection on solid organ transplant outcomes
Author(s) -
Taimur Sarah,
Pouch Stephanie M.,
Zubizarreta Nicole,
Mazumdar Madhu,
Rana Meenakshi,
Patel Gopi,
Freire Maristela Pinnheiro,
Pellett Madan Rebecca,
Kwak Eun Jeong,
Blumberg Emily,
Satlin Michael J.,
Pisney Larissa,
Clemente Wanessa Trindade,
Zervos Marcus J.,
La Hoz Ricardo M.,
Huprikar Shirish
Publication year - 2021
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.14239
Subject(s) - medicine , contraindication , klebsiella pneumoniae , bloodstream infection , colonization , cohort , liver transplantation , gastroenterology , transplantation , surgery , pathology , microbiology and biotechnology , escherichia coli , biology , biochemistry , chemistry , alternative medicine , gene
Abstract The impact of pre‐transplant (SOT) carbapenem‐resistant Enterobacterales (CRE) colonization or infection on post‐SOT outcomes is unclear. We conducted a multi‐center, international, cohort study of SOT recipients, with microbiologically diagnosed CRE colonization and/or infection pre‐SOT. Sixty adult SOT recipients were included (liver n = 30, hearts n = 17). Klebsiella pneumoniae ( n = 47, 78%) was the most common pre‐SOT CRE species. Median time from CRE detection to SOT was 2.32 months (IQR 0.33–10.13). Post‐SOT CRE infection occurred in 40% ( n = 24/60), at a median of 9 days (IQR 7–17), and most commonly due to K pneumoniae ( n = 20/24, 83%). Of those infected, 62% had a surgical site infection, and 46% had bloodstream infection. Patients with post‐SOT CRE infection more commonly had a liver transplant (16, 67% vs. 14, 39%; p =.0350) or pre‐SOT CRE BSI (11, 46% vs. 7, 19%; p =.03). One‐year post‐SOT survival was 77%, and those with post‐SOT CRE infection had a 50% less chance of survival vs. uninfected (0.86, 95% CI, 0.76–0.97 vs. 0.34, 95% CI 0.08–1.0, p =.0204). Pre‐SOT CRE infection or colonization is not an absolute contraindication to SOT and is more common among abdominal SOT recipients, those with pre‐SOT CRE BSI, and those with early post‐SOT medical and surgical complications.