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. 2017 Apr;101(4):811-820.
doi: 10.1097/TP.0000000000001620.

Carbapenem-Resistant Enterobacteriaceae Acquired Before Liver Transplantation: Impact on Recipient Outcomes

Maristela Pinheiro Freire  1 , Isabel C V S Oshiro, Ligia C Pierrotti, Patricia R Bonazzi, Larissa M de Oliveira, Alice T W Song, Carlos H Camargo, Inneke M van der Heijden, Flavia Rossi, Silvia F Costa, Luiz A C DʼAlbuquerque, Edson Abdala
Affiliations

Carbapenem-Resistant Enterobacteriaceae Acquired Before Liver Transplantation: Impact on Recipient Outcomes

Maristela Pinheiro Freire et al. Transplantation. 2017 Apr.

Abstract

Background: Carbapenem-resistant Enterobacteriaceae (CRE) is an emergent microorganism of infections after liver transplant (LT). The aim of this study was to analyze the risk factors for CRE acquisition and infection after LT.

Methods: This was a prospective cohort study involving patients who underwent LT in the 2010 to 2014 period. Surveillance cultures for CRE were collected immediately before LT and weekly thereafter until hospital discharge.

Results: We analyzed 386 patients undergoing a total of 407 LTs. Before LT, 68 (17.6%) patients tested positive for CRE, 11 (16.2%) of those patients having CRE infection, whereas 119 (30.8%) patients acquired CRE after LT. Post-LT CRE infection was identified in 59 (15.7%) patients: Klebsiella pneumoniae was isolated in 83.2%; surgical site infection was the most common type of infection (46.7%). Multivariate analysis showed that post-LT dialysis was the only risk factor for post-LT CRE acquisition. Eighty-two percent of patients who underwent 3 or more post-LT dialysis sessions and acquired CRE before LT evolved with post-LT CRE infection. Other risk factors for CRE infection were acquisition of CRE post-LT, Model for End-Stage Liver Disease score greater than 32, combined transplantation, and reoperation. Patients who acquired CRE before LT had a high risk of developing CRE infection (P < 0.001).

Conclusions: Measures for minimizing that risk, including altering the antibiotic prophylaxis, should be investigated and implemented.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Distribution of CRE infection according time of CRE acquisition.
FIGURE 2.
FIGURE 2.
Proportion of isolated strains that were blaKPC-producing, as well as the proportion that showed an elevated MIC for polymyxin, among 99 patients found to be infected with carbapenem-resistant Klebsiella pneumoniae between January 2010 and December 2014.
FIGURE 3.
FIGURE 3.
CART analysis of risk factors for infection with CRE among 386 patients undergoing LT. In blue boxes the incidence of CRE infection in that subgroup, in node square de P value for of the prediction of the outcome in this particular subgroup.
See this image and copyright information in PMC

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