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. 2024 Jan 11;6(1):dlad158.
doi: 10.1093/jacamr/dlad158. eCollection 2024 Feb.

Bloodstream infections after solid organ transplantation: clinical epidemiology and antimicrobial resistance (2016-21)

Max W Adelman  1   2   3   4 , Ashton A Connor  5   6   7 , Enshuo Hsu  8 , Ashish Saharia  5   6   7 , Constance M Mobley  5   6   7 , David W Victor 3rd  7 , Mark J Hobeika  5   6   7 , Jiejian Lin  1   4 , Kevin A Grimes  1   2   4 , Elizabeth Ramos  1 , Claudia Pedroza  9 , Elizabeth W Brombosz  6 , R Mark Ghobrial  5   6   7 , Cesar A Arias  1   2   4
Affiliations

Bloodstream infections after solid organ transplantation: clinical epidemiology and antimicrobial resistance (2016-21)

Max W Adelman et al. JAC Antimicrob Resist. .

Abstract

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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Figures

Figure 1.
Figure 1.
Flow diagram of SOT patients included.
Figure 2.
Figure 2.
Count of BSI episodes per individual patient, colour-coded by organ transplant type. Heart and kidney transplant recipients (lighter colours) had fewer BSI episodes, whereas liver and multi-organ transplant recipients (darker colours) were more highly represented among patients with multiple BSIs.
Figure 3.
Figure 3.
Number of BSIs caused by different organisms, grouped by organ transplant type and time since transplant.
Figure 4.
Figure 4.
Isolates causing BSIs (n = 323), categorized by antimicrobial resistance profiles, in the year after SOT. Areas are proportional to number of BSIs due to each specific organism. CSPA, carbapenem-susceptible P. aeruginosa; VSE, vancomycin-susceptible Enterococcus.
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