Prior Infection or Colonization with Carbapenem-Resistant Enterobacteriaceae Is Not an Absolute Contraindication for Solid Organ Transplantation.

S. Huprikar,¹ L. Casner,¹ S. Pouch,² M. Pinheiro Freire,³ R. Madan,⁴ E. Kwak,⁵ M. Satlin,⁶ P. Hartman,⁷ L. Pisney,⁸ P. Henrique Mourão,⁹ R. La Hoz,¹⁰ G. Patel.¹

¹Mount Sinai, New York
²Ohio State, Columbus
³Sao Paulo University, Sao Paulo, Brazil
⁴Albert Einstein, Bronx
⁵University of Pittsburgh, Pittsburgh
⁶Cornell, New York
⁷Henry Ford Health System, Detroit
⁸University of Colorado, Denver
⁹Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
¹⁰UT Southwestern, Dallas.

Meeting: 2016 American Transplant Congress

Abstract number: 161

Keywords: Bacterial infection, Outcome

Session Information

Session Name: Concurrent Session: Organ Transplantation in the Era of Highly Resistant Pathogens

Session Type: Concurrent Session

Date: Sunday, June 12, 2016

Session Time: 4:30pm-6:00pm

Presentation Time: 4:42pm-4:54pm

Location: Room 311

Background

Carbapenem-resistant Enterobacteriaceae (CRE) infection is associated with poor outcomes after solid organ transplantation (SOT). The significance of CRE colonization or infection prior to SOT is not known.

Methods

Patients who underwent SOT between 1/1/2007 and 7/31/2013 and had pre-SOT cultures positive for CRE were identified for chart review. The primary outcome was one-year mortality.

Results

57 SOT recipients from 10 sites were identified. The median age was 54 and 68% were male. 59 pre-SOT CRE isolates were identified: Klebsiella pneumoniae (n=45), Escherichia coli (5), Enterobacter (4), Klebsiella oxytoca (2), Serratia marcescens (2) and Citrobacter freundii (1). The culture sources of pre-SOT CRE were as follows: urine (22), rectal swab (21), blood (16), respiratory (9), others (10). The date of the most recent CRE culture was a median of 54 days (range: 1-2064) prior to SOT. The transplanted organs were as follows: liver (27), heart (17), kidney (7), liver-kidney (3), lung (2), and intestine (1). 22 (39%) patients developed CRE infection a median of 7.5 days (range: 2-151) after SOT. There was a surgical complication prior to CRE infection in 11/22 (50%) patients. The CRE causing infections were K. pneumoniae (19), Enterobacter (2), and Serratia (1) and matched the pre-SOT CRE in all patients except one. The sites of infection were as follows: bloodstream (11), surgical site or intra-abdominal (11), urinary tract (6), and pneumonia (5). One-year mortality was 21% (12/57) in the entire cohort; 27% (6/22) in patients with post-SOT CRE infection; and 17% (6/35) in patients without post-SOT CRE infection.

Conclusions

CRE colonization/infection should not be considered an absolute contraindication for SOT since one-year survival is nearly 80%. Strategies to prevent post-CRE infection may further improve survival. Analyses to identify risk factors associated with post-CRE infection and mortality are in progress.

CITATION INFORMATION: Huprikar S, Casner L, Pouch S, Pinheiro Freire M, Madan R, Kwak E, Satlin M, Hartman P, Pisney L, Henrique Mourão P, La Hoz R, Patel G. Prior Infection or Colonization with Carbapenem-Resistant Enterobacteriaceae Is Not an Absolute Contraindication for Solid Organ Transplantation. Am J Transplant. 2016;16 (suppl 3).

To cite this abstract in AMA style:

Huprikar S, Casner L, Pouch S, Freire MPinheiro, Madan R, Kwak E, Satlin M, Hartman P, Pisney L, Mourão PHenrique, Hoz RLa, Patel G. Prior Infection or Colonization with Carbapenem-Resistant Enterobacteriaceae Is Not an Absolute Contraindication for Solid Organ Transplantation. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/prior-infection-or-colonization-with-carbapenem-resistant-enterobacteriaceae-is-not-an-absolute-contraindication-for-solid-organ-transplantation/. Accessed November 21, 2024.

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