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. 2024 Feb 13;11(3):ofae060.
doi: 10.1093/ofid/ofae060. eCollection 2024 Mar.

The Burden and Impact of Early Post-transplant Multidrug-Resistant Organism Detection Among Renal Transplant Recipients, 2005-2021

Ahmed Babiker  1   2 , Geeta Karadkhele  3 , Andrei Bombin  1 , Rockford Watkins  1 , Chad Robichaux  4 , Gillian Smith  1   5   6 , Vivek B Beechar  1 , Danielle B Steed  1 , Jesse T Jacob  1 , Timothy D Read  1 , Sarah Satola  1 , Christian P Larsen  3 , Colleen S Kraft  1   2 , Stephanie M Pouch  1 , Michael H Woodworth  1
Affiliations

The Burden and Impact of Early Post-transplant Multidrug-Resistant Organism Detection Among Renal Transplant Recipients, 2005-2021

Ahmed Babiker et al. Open Forum Infect Dis. .

Erratum in

Abstract

Background: Reducing the burden of multidrug-resistant organism (MDRO) colonization and infection among renal transplant recipients (RTRs) may improve patient outcomes. We aimed to assess whether the detection of an MDRO or a comparable antibiotic-susceptible organism (CSO) during the early post-transplant (EPT) period was associated with graft loss and mortality among RTRs.

Methods: We conducted a retrospective cohort study of RTRs transplanted between 2005 and 2021. EPT positivity was defined as a positive bacterial culture within 30 days of transplant. The incidence and prevalence of EPT MDRO detection were calculated. The primary outcome was a composite of 1-year allograft loss or mortality following transplant. Multivariable Cox hazard regression, competing risk, propensity score-weighted sensitivity, and subgroup analyses were performed.

Results: Among 3507 RTRs, the prevalence of EPT MDRO detection was 1.3% (95% CI, 0.91%-1.69%) with an incidence rate per 1000 EPT-days at risk of 0.42 (95% CI, 0.31-0.57). Among RTRs who met survival analysis inclusion criteria (n = 3432), 91% (3138/3432) had no positive EPT cultures and were designated as negative controls, 8% (263/3432) had a CSO detected, and 1% (31/3432) had an MDRO detected in the EPT period. EPT MDRO detection was associated with the composite outcome (adjusted hazard ratio [aHR], 3.29; 95% CI, 1.21-8.92) and death-censored allograft loss (cause-specific aHR, 7.15; 95% CI, 0.92-55.5; subdistribution aHR, 7.15; 95% CI, 0.95-53.7). A similar trend was seen in the subgroup and sensitivity analyses.

Conclusions: MDRO detection during the EPT period was associated with allograft loss, suggesting the need for increased strategies to optimize prevention of MDRO colonization and infection.

Keywords: MDROs; allograft failure; renal transplant.

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Conflict of interest statement

Potential conflicts of interest. A.B. has served on a clinical advisory board for Beckman Coulter. All other authors: no reported conflicts.

Figures

Figure 1.
Figure 1.
Study flow diagram. aGroups not mutually exclusive. Abbreviations: CSO, comparative antibiotic-susceptible organism; MDRO, multidrug-resistant organism; RTR, renal transplant recipient.
Figure 2.
Figure 2.
Kaplan-Meier analysis of composite outcome of renal transplant recipients by early post-transplant positive culture status, 2005–2021 (n = 3432). Kaplan-Meier analysis of composite outcome comparing renal transplant recipients with a multidrug-resistant organism detected on early post-transplant culture (red), a comparative antibiotic-susceptible organism detected on post-transplant culture (green), and negative controls (blue) (B). Time is measured from transplant until event. Log-rank P = .01. Abbreviation: MDRO, multidrug-resistant organism.
Figure 3.
Figure 3.
Cumulative incidence curves for 1-year mortality and 1-year allograft loss of renal transplant recipients by early post-transplant positive culture status, 2005–2021 (n = 3432). Cumulative incidence curves for 1-year mortality (left panel, dashed line) and 1-year allograft loss (right panel, solid line) comparing renal transplant recipients with a multidrug-resistant organism detected on early post-transplant culture (red), a comparative antibiotic-susceptible organism detected on post-transplant culture (green), and negative controls (blue). Time is measured from transplant until event.
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References

    1. Centers for Disease Control and Prevention . Antibiotic Resistance Threats in the United States. US Department of Health and Human Services, Centers for Disease Control and Prevention; 2019.
    1. World Health Organization . Global Priority List of Antibiotic-Resistant Bacteria to Guide Research, Discover, and Development of New Antibiotics. World Health Organization; 2017.
    1. Pouch SM, Kubin CJ, Satlin MJ, et al. Epidemiology and outcomes of carbapenem-resistant Klebsiella pneumoniae bacteriuria in kidney transplant recipients. Transpl Infect Dis 2015; 17:800–9. - PMC - PubMed
    1. Anesi JA, Lautenbach E, Thom KA, et al. Clinical outcomes and risk factors for carbapenem-resistant Enterobacterales bloodstream infection in solid organ transplant recipients. Transplantation 2023; 107:254–63. - PMC - PubMed
    1. Murray CJL, Ikuta KS, Sharara F, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet 2022; 399:629–55. - PMC - PubMed