Objective: Solid organ transplant recipients (SOTR) have been disproportionately burdened by the emergence of multidrug-resistant bacteria, including carbapenem-resistant Enterobacteriaceae (CRE). We determined risk factors for and outcomes with CRE bloodstream infection (BSI) among SOTR.

Methods: A case-control and retrospective cohort study were conducted at the Hospital of the University of Pennsylvania from January 1, 2007 to July 1, 2016. All SOTR presenting with a BSI due to an Enterobacteriaceae (EB) were included. Case/exposed patients were those with a CRE BSI (defined by meropenem minimum inhibitory concentration [MIC] ≥4[micro]g/mL). Control/unexposed patients were those with a non-CRE EB BSI. The primary outcome in the time-to-event analysis was graft failure or death within 60 days of the index blood culture. Multivariable logistic and Cox proportional hazard regression analyses were performed.

Results: Of 287 total SOTR with an EB BSI, 17 (6%) were CRE. Significant independent risk factors for CRE BSI included: receipt of a lung transplant (adjusted odds ratio [aOR] 16.9, 95% confidence interval [CI] 3.68-77.7, P <0.01); third-generation cephalosporin exposure in the prior 6 months (aOR 8.68, 95% CI 1.90-39.8, P 0.01); daptomycin exposure in the prior 6 months (aOR 10.4, 95% CI 2.18-49.7, P <0.01); and increased age (aOR 1.12, 95% CI 1.03-1.22, P 0.01). In the outcomes analysis, there was a significantly higher hazard of graft failure or death associated with CRE BSI compared to non-CRE EB BSI (adjusted hazard ratio [aHR] 3.67, 95% confidence interval [CI] 1.16-11.65, P value 0.03) after adjusting for baseline factors, such as recent rejection, and severity of infection.

Conclusions: We identified a significant number of CRE BSI among SOTR. Modifiable risk factors for CRE BSI included recent exposure to a third-generation cephalosporin and daptomycin. Reduced allograft and patient survival were associated with CRE BSI, even after adjusting for baseline factors and severity of infection. Novel strategies to curb CRE emergence among SOTR are urgently needed.

CITATION INFORMATION: Anesi J., Blumberg E., Lautenbach E., Omorogbe J., Tolomeo P., Tamma P., Thom K., Alby K., Bilker W., Werzen A., Nemati K., Han J. Risk Factors and Outcomes with Carbapenem-Resistant Enterobacteriaceae Bloodstream Infections among Solid Organ Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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