TY - JOUR
T1 - Bloodstream infections after solid organ transplantation
T2 - clinical epidemiology and antimicrobial resistance (2016–21)
AU - Adelman, Max W.
AU - Connor, Ashton A.
AU - Hsu, Enshuo
AU - Saharia, Ashish
AU - Mobley, Constance M.
AU - Victor, David W.
AU - Hobeika, Mark J.
AU - Lin, Jiejian
AU - Grimes, Kevin A.
AU - Ramos, Elizabeth
AU - Pedroza, Claudia
AU - Brombosz, Elizabeth W.
AU - Ghobrial, R. Mark
AU - Arias, Cesar A.
N1 - Funding Information:
This work was supported by the National Institute of Allergy and Infectious Diseases at the National Institutes of Health (grant numbers K24AI121296, R01AI134637, R01AI148342 and P01AI152999 to C.A.A.) and by a Clinical Scholars Award granted by Houston Methodist to M.W.A.
Publisher Copyright:
© The Author(s) 2024. Published by Oxford University Press on behalf of NAR Cancer.
PY - 2024/2/1
Y1 - 2024/2/1
N2 - BACKGROUND: Solid organ transplant (SOT) recipients are at risk of bloodstream infections (BSIs) with MDR organisms (MDROs).OBJECTIVES: To describe the epidemiology of BSI in the year after several types of SOT, as well as the prevalence of MDRO infections in this population.METHODS: We conducted a single-centre, retrospective study of kidney, liver, heart, and multi-organ transplantation patients. We examined BSIs ≤1 year from SOT and classified MDRO phenotypes for
Staphylococcus aureus, enterococci, Enterobacterales,
Pseudomonas aeruginosa and
Candida spp. We compared BSI characteristics between SOT types and determined risk factors for 90 day mortality.
RESULTS: We included 2293 patients [1251 (54.6%) kidney, 663 (28.9%) liver, 219 (9.6%) heart and 160 (7.0%) multi-organ transplant]. Overall, 8.5% of patients developed a BSI. BSIs were most common after multi-organ (23.1%) and liver (11.3%) transplantation (
P < 0.001). Among 196 patients with BSI, 323 unique isolates were recovered, 147 (45.5%) of which were MDROs. MDROs were most common after liver transplant (53.4%). The most frequent MDROs were VRE (69.8% of enterococci) and ESBL-producing and carbapenem-resistant Enterobacterales (29.2% and 27.2% of Enterobacterales, respectively). Mortality after BSI was 9.7%; VRE was independently associated with mortality (adjusted OR 6.0, 95% CI 1.7-21.3).
CONCLUSIONS: BSI incidence after SOT was 8.5%, with a high proportion of MDROs (45.5%), especially after liver transplantation. These data, in conjunction with local antimicrobial resistance patterns and prescribing practices, may help guide empirical antimicrobial selection and stewardship practices after SOT.
AB - BACKGROUND: Solid organ transplant (SOT) recipients are at risk of bloodstream infections (BSIs) with MDR organisms (MDROs).OBJECTIVES: To describe the epidemiology of BSI in the year after several types of SOT, as well as the prevalence of MDRO infections in this population.METHODS: We conducted a single-centre, retrospective study of kidney, liver, heart, and multi-organ transplantation patients. We examined BSIs ≤1 year from SOT and classified MDRO phenotypes for
Staphylococcus aureus, enterococci, Enterobacterales,
Pseudomonas aeruginosa and
Candida spp. We compared BSI characteristics between SOT types and determined risk factors for 90 day mortality.
RESULTS: We included 2293 patients [1251 (54.6%) kidney, 663 (28.9%) liver, 219 (9.6%) heart and 160 (7.0%) multi-organ transplant]. Overall, 8.5% of patients developed a BSI. BSIs were most common after multi-organ (23.1%) and liver (11.3%) transplantation (
P < 0.001). Among 196 patients with BSI, 323 unique isolates were recovered, 147 (45.5%) of which were MDROs. MDROs were most common after liver transplant (53.4%). The most frequent MDROs were VRE (69.8% of enterococci) and ESBL-producing and carbapenem-resistant Enterobacterales (29.2% and 27.2% of Enterobacterales, respectively). Mortality after BSI was 9.7%; VRE was independently associated with mortality (adjusted OR 6.0, 95% CI 1.7-21.3).
CONCLUSIONS: BSI incidence after SOT was 8.5%, with a high proportion of MDROs (45.5%), especially after liver transplantation. These data, in conjunction with local antimicrobial resistance patterns and prescribing practices, may help guide empirical antimicrobial selection and stewardship practices after SOT.
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U2 - 10.1093/jacamr/dlad158
DO - 10.1093/jacamr/dlad158
M3 - Article
C2 - 38213312
AN - SCOPUS:85182548939
SN - 2632-1823
VL - 6
SP - dlad158
JO - JAC-Antimicrobial Resistance
JF - JAC-Antimicrobial Resistance
IS - 1
M1 - 158
ER -