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. 2021 Sep:115:83-92.
doi: 10.1016/j.jhin.2021.05.006. Epub 2021 May 24.

Critical points and potential pitfalls of outbreak of IMP-1-producing carbapenem-resistant Pseudomonas aeruginosa among kidney transplant recipients: a case-control study

M P Freire  1 , C H Camargo  2 , A Y Yamada  2 , F O Nagamori  2 , J O Reusing Junior  3 , F Spadão  4 , A P Cury  5 , F Rossi  5 , W C Nahas  3 , E David-Neto  3 , L C Pierrotti  6
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Critical points and potential pitfalls of outbreak of IMP-1-producing carbapenem-resistant Pseudomonas aeruginosa among kidney transplant recipients: a case-control study

M P Freire et al. J Hosp Infect. 2021 Sep.

Abstract

Background: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) infection after kidney transplantation (KT) is associated with high mortality.

Aim: To analyse an outbreak of infection/colonization with IMP-1-producing CRPA on a KT ward.

Methods: A case-control study was conducted. Cases were identified through routine surveillance culture and real-time polymerase chain reaction for carbapenemase performed directly from rectal swab samples. Controls were randomly selected from patients hospitalized on the same ward during the same period, at a ratio of 3:1. Strain clonality was analysed through pulsed-field gel electrophoresis (PFGE), and whole-genome sequencing was performed for additional strain characterization.

Findings: CRPA was identified in 37 patients, in 51.4% through surveillance cultures and in 49.6% through clinical cultures. The median persistence of culture positivity was 42.5 days. Thirteen patients (35.1%) presented a total of 15 infections, of which seven (46.7%) were in the urinary tract; among those, 30-day mortality rate was 46.2%. PFGE analysis showed that all of the strains shared the same pulsotype. Multilocus sequence typing analysis identified the sequence type as ST446. Risk factors for CRPA acquisition were hospital stay >10 days, retransplantation, urological surgical reintervention after KT, use of carbapenem or ciprofloxacin in the last three months and low median lymphocyte count in the last three months.

Conclusion: KT recipients remain colonized by CRPA for long periods and could be a source of nosocomial outbreaks. In addition, a high proportion of such patients develop infection. During an outbreak, urine culture should be added to the screening protocol for KT recipients.

Keywords: Antimicrobial use; Carbapenem resistance; Kidney transplantation; Lymphopenia; Real-time PCR; Retransplantation; Surveillance cultures.

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