Clinical Outcomes and Risk Factors for Carbapenem-resistant Enterobacterales Bloodstream Infection in Solid Organ Transplant Recipients

Details

• Alternative Title:
  Transplantation
• Personal Author:
  Anesi, Judith A. ; Lautenbach, Ebbing ; Thom, Kerri A. ; Tamma, Pranita D. ; Blumberg, Emily A. ; Alby, Kevin ; Bilker, Warren B. ; Werzen, Alissa ; Ammazzalorso, Alyssa ; Tolomeo, Pam ; Omorogbe, Jacqueline ; Pineles, Lisa ; Han, Jennifer H.
• Description:
  Background.
  
  The clinical outcomes associated with, and risk factors for, carbapenem-resistant Enterobacterales (CRE) bloodstream infections (BSIs) in solid organ transplant (SOT) recipients remain ill-defined.
  
  Methods.
  
  A multicenter retrospective cohort study was performed, including SOT recipients with an Enterobacterales BSI between 2005 and 2018. Exposed subjects were those with a CRE BSI. Unexposed subjects were those with a non-CRE BSI. A multivariable survival analysis was performed to determine the association between CRE BSI and risk of all-cause mortality within 60 d. Multivariable logistic regression analysis was performed to determine independent risk factors for CRE BSI.
  
  Results.
  
  Of 897 cases of Enterobacterales BSI in SOT recipients, 70 (8%) were due to CRE. On multivariable analysis, CRE BSI was associated with a significantly increased hazard of all-cause mortality (adjusted hazard ratio, 2.85; 95% confidence interval [CI], 1.68-4.84; P < 0.001). Independent risk factors for CRE BSI included prior CRE colonization or infection (adjusted odds ratio [aOR] 9.86; 95% CI, 4.88-19.93; P < 0.001), liver transplantation (aOR, 2.64; 95% CI, 1.23-5.65; P = 0.012), lung transplantation (aOR, 3.76; 95% CI, 1.40-10.09; P = 0.009), and exposure to a third-generation cephalosporin (aOR, 2.21; 95% CI, 1.17-4.17; P = 0.015) or carbapenem (aOR, 2.80; 95% CI, 1.54-5.10; P = 0.001) in the prior 6 months.
  
  Conclusions.
  
  CRE BSI is associated with significantly worse outcomes than more antibiotic-susceptible Enterobacterales BSI in SOT recipients.
  
  
• Subjects:
  Anti-Bacterial Agents Bacteremia Carbapenems Humans Liver Transplantation Retrospective Studies Risk Factors Sepsis Transplant Recipients
• Source:
  Transplantation. 107(1):254-263
• Pubmed ID:
  35856636
• Pubmed Central ID:
  PMC9772065
• Document Type:
  Journal Article
• Funding:
  K01 AI137317/AI/NIAID NIH HHSUnited States/ ; L30 AI133754/AI/NIAID NIH HHSUnited States/ ; U54 CK000163/CK/NCEZID CDC HHSUnited States/
• Volume:
  107
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:8365897b60d2df6285c184b413030057142be003239d22cc18fb37447c0b6dfc
• Download URL:
  https://stacks.cdc.gov/view/cdc/123020/cdc_123020_DS1.pdf
• File Type:
  [PDF - 454.04 KB ]