Background: Preventive strategies to combat the transmission of Carbapenem-Resistant Enterobacteriaceae (CRE) include the use of active screening for CRE colonization; however, this approach is not standard of care for liver transplant (LT) candidates or recipients. Our study aims to describe the epidemiological characteristics and clinical outcomes of LT recipients who underwent active screening for CRE carriage before and after LT.

Methods: We reviewed the chart of adult patients (age ≥ 18 years) who underwent a successful orthotopic liver transplant (defined as graft survival > 30 days) from August 2014 to November 2016 with documented rectal swabs for CRE colonization pre and post LT. CRE carriage was defined as the isolation of CRE from a rectal swab in the absence of symptoms of invasive infection. The following endpoints were assessed: rates of CRE carriage, post-transplant CRE infections, graft function at one year, and rates of culture discordance.

Results: Sixty-five patients underwent LT during the study period and were included in our analysis. Of the 51 transplant recipients screened, CRE rectal carriage was detected in 3 patients (5% incidence rate). No acquisition of an invasive CRE infection was observed in all colonized patients. Two patients with pre-LT CRE colonization received a pharmacologic intervention with ceftazidime-avibactam as the peri-operative antibiotic. Seven patients developed an invasive CRE infection within 1-year post-LT, three of which had a pre-LT negative screen. Medical and/or surgical complications occurred within 5 of the 7 patients post LT, which may have increased their risk for CRE acquisition. No CRE rectal culture discordance was detected among patients with negative screens. Graft failure occurred in 11 patients (17%), of which two were attributed to infection.

Conclusion: Where CRE is endemic, active screening for CRE carriage may be beneficial for LT candidates in deciding preoperative antibiotics and proper placement of infection prevention measures. Risk stratification tools may help discriminate patients at low and high risk for CRE acquisition and assist with resource allocation for preventive strategies including active surveillance.

CITATION INFORMATION: Bias T, Malat G, Lee D, Talluri S, Ranganna K, Epstein S, Patel V, Guy S. Outcomes of Active Screening for Carbapenem-Resistant Enterobacteriaceae among Liver Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).

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