Infection in Solid Organ Transplant Recipients: Focus on Multi drug-resistant organisms

Abstract

Background: Infection in transplantation is still an important cause of morbimortality. In the era of multidrug-resistant organisms (MDRO) this condition gets even worse. Methods & Materials: We analyzed all organ transplants (Tx) performed in our center, during 2015 and 2016. Data were prospectively obtained. We described incidence and type of infections, percentage of MDRO, risk factors for MDRO infection, and mortality. Patients who died or had the organ explanted within 72 hs were excluded. Results: 264 Tx were included: 118 kidney (KT), 62 heart (HT), 52 liver(LT), 15 kidney-pancreas (KPT) and 17 lung (LT). 173 (65.5%) presented infectious episodes (ep.),138 pat. (52%) presented 292 ep. of bacterial infection (BI). HT and LT had lower incidence of BI. 109 pat. presented MDRO infections. 210/292 (72%) BI were caused by MDRO. The lowest incidence of MDRO was observed in HT.Tabled 1Organismn°MDROResistanceTransplantKlebsiella pn.132112 (83.5%)KPC 12 (11%)all TxE. coli4825 (48%)Ps. ae4117 (41%)MBL 3 (7%)LTOther enterobacteria2928 (96.5%)Acinetobacter1917 (89%)Enterococcus182 (12%)S. aureus54 (80%)Other377 (19%) Open table in a new tab The most frequent localization in KT and KPT was urinary tract (66 and 67%), in LT was abdominal (46%), In HT respiratory and urinary (32 and 34%) and in LT respiratory (78%). Thirty-four of 292 ep. were surgical site infections.(11.5%), this type of infection was more frequent in KPT and LT. MDRO infection did not correlate with mortality, except in LT: 60% in pat. with MDRO vs 21% in pat. without MDRO infection: p = 0.019. MDRO infection did not correlate either with age, localization of infection, or retransplantation. In KT infection with MDRO correlated with type of donor: living-donor 13/47 and deceased donor 45/71 p = 0.00012 Conclusion: MDRO infections are very frequent in our population. These infections correlated with mortality in LT recipients. It is relevant to learn about resistance of microorganisms in transplant recipients, so as to indicate adequate empirical antibiotic treatment