Multidrug-Resistant Enterobacterales Colonization, Infections Frequent Following Transplantation

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Multidrug-resistant (MDR) Enterobacterales colonized within the gastrointestinal (GI) tract was discovered to be an unbiased threat issue for infections in sufferers following liver, lung, or small bowel transplant, in keeping with research outcomes printed in Medical Infectious Ailments. Though the incidence of mortality was low, recurrent infections as a consequence of GI-colonizing strains have been widespread, occurring as late as nearly 4 years after the unique an infection.

On this potential, single-center research carried out on the College of Pittsburgh in Pennsylvania, researchers aimed to find out the long-term outcomes of MDR Enterobacterales, outlined as carbapenem-resistant Enterobacterales (CRE) and third-generation cephalosporin-resistant Enterobacterales (3GCREB) colonization and infections amongst stable organ transplant recipients.

The first outcomes have been colonization and an infection attributable to GI strains at 100 days and 6 months post-transplant, respectively. Secondary outcomes have been mortality and recurrent infections post-transplant. Analyses have been carried out utilizing perirectal swabs that have been collected and cultured on a weekly foundation as much as 100 days post-transplant.

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Of the 162 sufferers (median age, 57 years; 59% males; 89% White) included within the research, lung, liver, and small bowel transplantation occurred in 88, 70, and 4 sufferers, respectively. Inside 100 days post-transplant, 25% (40/162) of sufferers have been colonized with MDR Enterobacterales and 11 have been colonized with greater than 1 MDR Enterobacterales. Klebsiella pneumoniae was the commonest MDR Enterobacterales with Okay pneumoniae carbapenemases, and CTX-M was the main explanation for CRE and 3GCREB, respectively.

Inside 6 months post-transplant, 35% (14/40) of sufferers who had GI colonization developed infections vs solely 2% (3/145) of these with out colonization (P <.0001). Colonization and an infection charges didn’t differ between liver and lung recipients nor between CRE and 3GCREB. Nevertheless, an infection charges have been greater following CRE than 3GCREB colonization (53% vs 21%; P =.049).

In multivariate evaluation, unbiased threat elements for MDR Enterobacterales and 3GCREB infections have been GI colonization (P <.0001 and P =.008, respectively) and excessive physique mass index (P =.004 for each). For CRE infections, unbiased threat elements have been GI colonization (P <.0001) and surgical re-exploration after transplant (P =.016).

With a median follow-up of 4.3 years post-transplant, mortality didn’t considerably differ between sufferers with and with out infections (29% vs 23%; P =.56). Though mortality was low, recurrent infections occurred in 44% of survivors, with 43% of recurrences occurring between 285 days and three.9 years after the preliminary an infection.

Complete genome sequencing phylogenetic analyses “revealed that infections have been attributable to GI-colonizing strains, and steered unrecognized transmission of novel clonal group-258 sublineage CR-Okay pneumoniae and horizontal switch of resistance genes,” famous the researchers.

Limitations included this being a single-center research, not screening sufferers earlier than transplantation, utilizing perirectal swabs as an alternative of polymerase chain response testing, and an absence of sufferers present process kidney transplant.

“Excessive MDR-[Enterobacterales] colonization and an infection charges, hyperlinks between colonization and invasive an infection, and proof of genetic relatedness between colonizing and infection-causing strains present rationale for routine surveillance of liver, lung, and small bowel recipients,” concluded the researchers.

Disclosure: Some authors declared affiliations with biotech, pharmaceutical, and/or system corporations. Please see the unique reference for a full listing of authors’ disclosures.


Nguyen MH, Shields RK, Chen L, et al. Molecular epidemiology, pure historical past and long-term outcomes of multi-drug resistant Enterobacterales colonization and infections amongst stable organ transplant recipients. Clin Infect Dis. Revealed on-line Might 10, 2021. doi:10.1093/cid/ciab427

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