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Published on: November 7, 2020
Prevalence and Clinical Impact of Multidrug-Resistant Bacterial Colonization and Infection in Liver Transplant
Eqbal B Qaddour1, Duaa W Albunni, Aiman Y Alwadi
1>From the Department of Pharmacy and Biomedical Sciences, MAHSA University, Selangor, Malaysia.
Objectives:
To our knowledge, a systematic review that has comprehensively evaluated the prevalence and clinical impact of multidrug -resistant bacteria in adult liver transplant recipients is not available. This review assessed the prevalence and clinical impact of multidrug -resistant bacteria among liver transplant recipients.
Materials And Methods:
In accordance with PRISMA guidelines, we searched Web of Science, PubMed, and Google Scholar through August 2025. The study protocol was registered in PROSPERO (CRD420251181202 ). We included cohort and case -control studies that reported on adult first liver transplant recipients harboring and not harboring multidrug -resistant bacteria. Two reviewers assessed eligibility and conducted a risk of bias evaluation using the Newcastle -Ottawa Scale. We synthesized data using the web -based Review Manager for a meta -analysis, with a random -effects model to compute the pooled odds ratio and 95 % CI. Statistical heterogeneity was determined using the I2 statistic.
Results:
In the 13 included studies (12 cohort studies, 1 case -control study ), multidrug -resistant bacteria were identified in 507 of 28 599 liver transplant recipients. Multidrug -resistant bacteria colonization significantly increased posttransplant infection (odds ratio 5.98; 95 % CI, 2.24 -15.94 ), and their presence significantly increased mortality (odds ratio 5.32; 95 % CI, 2.36 -11.97 ). Subgroup analyses suggested a regional variation in mortality risk with a higher association in China and Japan (odds ratio, 22.26; 95 % CI, 6.83 -72.6 ). Exposure to these bacteria was also associated with prolonged hospital and intensive care unit stay and showed a borderline association with acute kidney injury but not with graft rejection.
Conclusions:
Colonization with multidrug -resistant bacteria is associated with increased infection, and both colonization and infection raise the risk of mortality. Despite the variations across studies in geography, follow -up duration, and screening methods, actions to prevent colonization in transplant candidates are warranted.
Insights
Multidrug-resistant bacteria colonization significantly increases infection and mortality risk in adult liver transplant recipients. Prevention strategies for transplant candidates are crucial to mitigate these severe outcomes.
Area of Science:
- Transplantation Medicine
- Infectious Diseases
- Microbiology
Background:
- Multidrug-resistant bacteria (MDRB) pose a significant threat in immunocompromised patients.
- Liver transplant recipients are particularly vulnerable to infections due to their compromised immune status.
Conclusions:
- Colonization with MDRB is strongly linked to increased infection rates and mortality in liver transplant recipients.
- Geographical variations exist, but preventive actions for transplant candidates are warranted.
- Further research may refine screening and prevention strategies for MDRB in this vulnerable population.
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