Related Experiment Video
Updated: Mar 7, 2026
Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Factors influencing mortality in abdominal solid organ transplant recipients with multidrug-resistant gram-negative
Bingbing Qiao1, Jianzhen Wu2, Qiquan Wan3
1Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, People's Republic of China.
Background:
Although multidrug-resistant (MDR) gram-negative bacteremia (GNB) has been recognized as an important cause of morbidity and mortality among abdominal solid organ transplant (ASOT) recipients, there are no data on its prognostic factors after an interim standard definition of MDR was proposed in 2012. The objective of this study was to describe the epidemiology, microbiology, and predictors of infection-related 30-day mortality in ASOT recipients with MDR GNB.
Methods:
We performed a retrospective, double-center analysis of ASOT patients with MDR GNB over a 13-year study period. Univariate and multivariate analyses were performed to identify the risk factors for mortality.
Results:
During the observational period, 2169 subjects underwent ASOT. Ninety-nine episodes of MDR GNB were diagnosed in 91 (4.6%) ASOT recipients, with a predominance of E.coli (29 isolates, 29.3%) and A.baumanii (24 isolates, 24.2%). The median age of these 91 recipients was 45 years (interquartile range 35-54). Mortality after the first episode of MDR GNB was 39.6% (36 deaths). The univariate analysis identified the following variables as predictors of MDR GNB-related mortality: lung focus (P = 0.001),nosocomial origin (P = 0.002), graft from donation after cardiac death or deceased donors (P = 0.023), presence of other concomitant bloodstream infection (P < 0.001), temperature of 40 °C or greater at the onset of MDR GNB (P = 0.039), creatinine > 1.5 mg/dl (P = 0.006), albumin < 30 g/L (P = 0.009), platelet count < 50,000/mm3 (P < 0.001), and septic shock (P < 0.001). In the multivariate logistic regression analysis, septic shock (odds ratio (OR) = 160.463, 95% confidence interval (CI) = 19.377-1328.832, P < .001), as well as creatinine > 1.5 mg/dl (OR = 24.498, 95% CI = 3.449-173.998, P = 0.001), nosocomial origin (OR = 23.963, 95% CI = 1.285-46.991, P = 0.033), and presence of other concomitant bloodstream infections (OR = 27.074, 95% CI = 3.937-186.210, P = 0.001) were the variables associated with MDR GNB-related 30-day mortality.
Conclusions:
MDR GNB was associated with high morbidity and mortality in ASOT recipients, with a predominant causative organisms being E.coli and A.baumanii. Nosocomial origin, as well as presence of other concomitant bloodstream infections, increased creatinine level and septic shock were the main predictors of MDR GNB-related 30-day mortality.
Insights
Multidrug-resistant gram-negative bacteremia (MDR GNB) poses a significant threat to abdominal solid organ transplant recipients. Septic shock, elevated creatinine, nosocomial origin, and other bloodstream infections are key predictors of 30-day mortality.
Area of Science:
- Transplant Surgery
- Infectious Diseases
- Critical Care Medicine
Background:
- Multidrug-resistant gram-negative bacteremia (MDR GNB) is a major cause of morbidity and mortality in abdominal solid organ transplant (ASOT) recipients.
- Previous studies lacked data on prognostic factors for MDR GNB in ASOT recipients following the 2012 interim definition.
Purpose of the Study:
- To describe the epidemiology and microbiology of MDR GNB in ASOT recipients.
- To identify predictors of 30-day infection-related mortality in ASOT recipients with MDR GNB.
Main Methods:
- Retrospective analysis of ASOT patients with MDR GNB over 13 years at two centers.
- Univariate and multivariate logistic regression analyses to identify risk factors for mortality.
Main Results:
- 99 episodes of MDR GNB occurred in 91 (4.6%) ASOT recipients, predominantly caused by E. coli and A. baumannii.
- 30-day mortality was 39.6%.
- Multivariate analysis identified septic shock, elevated creatinine (>1.5 mg/dl), nosocomial origin, and concomitant bloodstream infections as significant predictors of mortality.
Conclusions:
- MDR GNB is associated with high morbidity and mortality in ASOT recipients.
- E. coli and A. baumannii are the most common pathogens.
- Septic shock, nosocomial origin, elevated creatinine, and co-infections are critical predictors of 30-day mortality in this patient population.
Related Concept Videos
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:16Kidney Transplant III: Nursing Management
01:28Kidney Transplant I: Introduction
01:29Pulmonary Tuberculosis I
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
01:26Kidney Transplant II: Surgical Procedure
01:24Drug Toxicity: Risk factors