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Published on: December 8, 2014
Clinical outcomes of intestinal transplant recipients colonized with multidrug-resistant organisms: a retrospective
Jacques Simkins1, Michele I Morris1, Jose F Camargo1
1Department of Medicine/Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA.
Abstract:
Rates of multidrug-resistant organisms (MDRO) colonization among intestinal transplant (ITx) recipients have not been reported. Colonization rates with vancomycin-resistant Enterococcus (VRE), carbapenem-resistant Gram-negative bacteria (CR-GNB), and methicillin-resistant Staphylococcus aureus (MRSA) were obtained retrospectively in adults undergoing ITx (isolated or multivisceral) from 1/2009 to 12/2015. We assessed for VRE, CR-GNB, and MRSA bacteremia during the first year post-transplant for patients colonized with VRE, CR-GNB, and MRSA, respectively, and for those who were not colonized. We evaluated whether the number of hospitalization days and one year post-transplant survival were different in MDRO-colonized patients. Forty-five ITx recipients were identified. Twenty-eight (62%) were colonized with MDRO [VRE in 22 (50%) patients, MRSA in seven (16%), and CR-GNB in six (15%)]. VRE and CR-GNB-colonized patients were more likely to develop VRE and CR-GNB bacteremia, respectively, than noncolonized patients [8/22 (36%) vs. 1/23 (4%), and 4/6 (67%) vs. 2/39 (5%), P < 0.05 for both]. There was no difference in one-year survival between MDRO-colonized and noncolonized patients. However, survival was lower among MDRO-colonized patients who developed VRE, CR-GNB, or MRSA bacteremia (P < 0.001). MDRO colonization was common among our ITx recipients. VRE and CR-GNB bacteremia was more common among colonized patients, and survival was lower among MDRO-colonized patients who developed bacteremia.
Insights
Multidrug-resistant organism colonization is common in intestinal transplant recipients. Colonized patients face higher risks of bacteremia, impacting survival, underscoring the need for targeted interventions.
Area of Science:
- Transplant Surgery
- Infectious Diseases
- Microbiology
Background:
- Rates of multidrug-resistant organism (MDRO) colonization in intestinal transplant (ITx) recipients remain largely unreported.
- Understanding colonization patterns is crucial for managing post-transplant complications.
Purpose of the Study:
- To determine the prevalence of MDRO colonization in adult ITx recipients.
- To assess the association between MDRO colonization and subsequent bacteremia.
- To evaluate the impact of MDRO colonization on hospitalization duration and one-year survival post-ITx.
Main Methods:
- Retrospective analysis of 45 adult ITx recipients from January 2009 to December 2015.
- Assessment of colonization with vancomycin-resistant Enterococcus (VRE), carbapenem-resistant Gram-negative bacteria (CR-GNB), and methicillin-resistant Staphylococcus aureus (MRSA).
- Comparison of bacteremia rates, hospitalization days, and one-year survival between colonized and non-colonized patients.
Main Results:
- 62% of ITx recipients (28/45) were colonized with MDRO, including VRE (50%), MRSA (16%), and CR-GNB (15%).
- Colonized patients with VRE and CR-GNB had significantly higher rates of developing respective bacteremias compared to non-colonized patients (36% vs. 4% for VRE; 67% vs. 5% for CR-GNB).
- While overall one-year survival did not differ, survival was significantly lower in MDRO-colonized patients who developed bacteremia (P < 0.001).
Conclusions:
- MDRO colonization is a frequent occurrence in intestinal transplant recipients.
- Colonization with VRE and CR-GNB increases the likelihood of subsequent bacteremia.
- MDRO colonization, particularly when leading to bacteremia, adversely affects survival in ITx patients.
