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Organ donor screening for carbapenem-resistant gram-negative bacteria in Italian intensive care units: the DRIn study

Francesco Procaccio1, Lucia Masiero1, Francesca Vespasiano1

  • 1Centro Nazionale Trapianti, Istituto Superiore di Sanità, Rome, Italy.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|August 11, 2019
PubMed

Insights

Carbapenem-resistant gram-negative bacteria (CR-GN) were found in Italian organ donors, posing a risk to recipients. Early detection and improved infection control in intensive care units are crucial to prevent donor-derived sepsis and save lives.

Area of Science:

  • Infectious Diseases
  • Critical Care Medicine
  • Transplantation

Background:

  • Carbapenem-resistant gram-negative bacteria (CR-GN) pose a significant threat in healthcare settings, particularly in intensive care units (ICUs).
  • Organ donation and transplantation involve complex processes where infectious agents can be transmitted from donor to recipient.
  • National guidelines exist for screening organ donors, but adherence and effectiveness require evaluation.

Purpose of the Study:

  • To quantify CR-GN isolation in organ donors undergoing brain death declaration (BDD) in Italian ICUs.
  • To assess adherence to national screening guidelines for CR-GN in organ donors.
  • To identify risk factors associated with CR-GN isolation in organ donors and evaluate the impact on organ recipients.

Main Methods:

  • Retrospective study of 759 brain death declaration cases in 190 Italian ICUs (May-September 2012).
  • Analysis of mandatory blood, bronchoalveolar lavage, and urine cultures from organ donors.
  • Evaluation of transplant outcomes and recipient data in relation to donor CR-GN status.

Main Results:

  • Over 20% of transplants proceeded without complete microbiological information, with organs from 15 of 22 CR-GN cases being used.
  • Two recipients (lung-liver) died from likely donor-derived CR-GN sepsis.
  • Risk factors for CR-GN isolation included ICU stay >3 days, fever, age <60 years, and positive ICU epidemiology. Significant variation in CR-GN risk was observed across ICUs, suggesting issues with infection control practices.

Conclusions:

  • Inadequate microbiological screening before transplantation and suboptimal infection control in ICUs contribute to the risk of CR-GN transmission.
  • There is a critical need for continuous education on infection control, antimicrobial stewardship, and early CR-GN detection in ICUs and transplant networks.
  • Implementing timely alert systems and improving awareness can enhance decision-making regarding organ suitability and potentially prevent recipient mortality.
Keywords:
clinical research/practicedonors and donation: donation after brain death (DBD)donors and donation: donor evaluationinfection and infectious agents - bacterialorgan procurement and allocationrisk assessment/risk stratification

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