TY - JOUR
T1 - Impact of pre-transplant carbapenem-resistant Enterobacterales colonization and/or infection on solid organ transplant outcomes
AU - Taimur, Sarah
AU - Pouch, Stephanie M.
AU - Zubizarreta, Nicole
AU - Mazumdar, Madhu
AU - Rana, Meenakshi
AU - Patel, Gopi
AU - Freire, Maristela Pinnheiro
AU - Pellett Madan, Rebecca
AU - Kwak, Eun Jeong
AU - Blumberg, Emily
AU - Satlin, Michael J.
AU - Pisney, Larissa
AU - Clemente, Wanessa Trindade
AU - Zervos, Marcus J.
AU - La Hoz, Ricardo M.
AU - Huprikar, Shirish
N1 - Publisher Copyright:
© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
PY - 2021/4
Y1 - 2021/4
N2 - 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.
AB - 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.
KW - carbapenem-resistant enterobacterales
KW - multidrug-resistant organisms
KW - solid organ transplantation
UR - http://www.scopus.com/inward/record.url?scp=85100591792&partnerID=8YFLogxK
U2 - 10.1111/ctr.14239
DO - 10.1111/ctr.14239
M3 - Article
C2 - 33527453
AN - SCOPUS:85100591792
SN - 0902-0063
VL - 35
JO - Clinical Transplantation
JF - Clinical Transplantation
IS - 4
M1 - e14239
ER -