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Multidrug-resistant organism bloodstream infections in solid organ transplant recipients and impact on mortality: a
Alice J Liu1, Adelaide S M Dennis1, Zarin Fariha1
1Department of Infectious Diseases, The Alfred Hospital and School of Translational Medicine, Monash University, Melbourne, Australia.
Background:
Bloodstream infections (BSIs) cause significant morbidity and mortality in solid organ transplant (SOT) recipients. There are few data regarding the contribution of MDR organisms (MDROs) to these infections. We evaluated the resistance percentage of MDRO BSIs in SOT recipients and the associated mortality.
Methods:
A systematic review of MEDLINE and Embase databases up to January 2024, for studies of adult SOT recipients that quantified MDRO BSI resistance percentage and/or associated crude mortality. MDROs studied were carbapenem-resistant Enterobacterales (CRE), Acinetobacter baumannii (CRAB) and Pseudomonas aeruginosa (CRPA), third-generation cephalosporin-resistant Enterobacterales (3GCR-E), MRSA and VRE. Resistance percentage and mortality outcomes were reported as median (IQR) and crude mortality (%), respectively.
Results:
Of 945 studies identified, 52 were included. Most were retrospective (41/52) and/or single centre (37/52), and liver transplantation was the most frequently studied SOT type (22/52). High resistance percentages of BSIs were noted, ranging from 13.6% CRE for Enterobacterales to 59.2% CRAB for A. baumannii. Resistance percentage trends decreased over time, but these changes were not statistically significant. Asia had the highest resistance percentages for MRSA [86.2% (IQR 77.3%-94.6%)], 3GCR-E [59.5% (IQR 40.5%-66.7%)] and CRE [35.7% (IQR 8.3%-63.1%)]. North America had the highest VRE resistance percentages [77.7% (IQR 54.6%-94.7%)]. Crude mortality was 15.4%-82.4% and was consistently higher than for non-MDRO BSIs.
Conclusions:
MDRO BSI resistance percentages were high for all pathogens studied (IQR 24.6%-69.4%) but there was geographical and temporal heterogeneity. MDRO BSIs were associated with high mortality in SOT recipients. Microbiological and clinical data in this vulnerable population were incomplete, highlighting the need for robust international multicentre studies.
Insights
Multidrug-resistant organism bloodstream infections (MDRO BSIs) are a significant threat to solid organ transplant (SOT) recipients, exhibiting high resistance percentages and mortality rates. Further international research is needed to address data gaps in this vulnerable population.
Area of Science:
- Infectious Diseases
- Transplantation Medicine
- Antimicrobial Resistance
Background:
- Bloodstream infections (BSIs) are a major cause of illness and death in solid organ transplant (SOT) recipients.
- Data on the impact of multidrug-resistant organisms (MDROs) on BSIs in SOT patients are limited.
- This study evaluates the resistance rates of MDRO BSIs and their associated mortality in SOT recipients.
Purpose of the Study:
- To quantify the resistance percentages of various multidrug-resistant organisms (MDROs) causing bloodstream infections (BSIs) in solid organ transplant (SOT) recipients.
- To determine the crude mortality associated with MDRO BSIs in this patient population.
- To identify geographical and temporal trends in MDRO resistance.
Main Methods:
- A systematic review of MEDLINE and Embase databases was conducted up to January 2024.
- Studies involving adult SOT recipients with quantified MDRO BSI resistance percentages or crude mortality were included.
- Key MDROs analyzed included carbapenem-resistant Enterobacterales (CRE), Acinetobacter baumannii (CRAB), Pseudomonas aeruginosa (CRPA), third-generation cephalosporin-resistant Enterobacterales (3GCR-E), MRSA, and VRE.
Main Results:
- Fifty-two studies were included, predominantly retrospective and single-center, with liver transplantation being the most common SOT type.
- High resistance percentages were observed across MDROs, ranging from 13.6% for CRE to 59.2% for CRAB.
- Crude mortality for MDRO BSIs ranged from 15.4% to 82.4%, consistently higher than for non-MDRO BSIs, with geographical variations noted.
Conclusions:
- MDRO BSIs demonstrate high resistance percentages with significant geographical and temporal heterogeneity in SOT recipients.
- These infections are associated with substantial mortality in this vulnerable patient group.
- Incomplete microbiological and clinical data underscore the necessity for robust international multicenter studies.
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