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3. Nosocomial bloodstream infections in a nationwide study: comparison between solid organ transplant patients and the general population.

Author

Camargo, L.F.A., Marra, A.R., Pignatari, A.C.C., Sukiennik, T., Behar, P.P.P., Medeiros, E.A.S., Ribeiro, J., Girão, E., Correa, L., Guerra, C., Brites, C., Pereira, C.A.P., Carneiro, I., Reis, M., Souza, M.A., Barata, C.U., and Edmond, M.B.

Subjects
*NOSOCOMIAL infections, *TRANSPLANTATION of organs, tissues, etc., *MULTIDRUG resistance, *DISEASE incidence, *PUBLIC health surveillance, *PATIENTS
Abstract

Background The incidence of bloodstream infection ( BSI) varies according to the transplanted organ. Mortality can be as high as 24%, with a significant impact on graft survival. Transplantation is a risk factor for multidrug-resistant ( MDR) organisms, but comparison with a non-transplanted population in a single large cohort has not been described. Methods This is a prospective nationwide study (16 centers) reporting data on 2364 monomicrobial nosocomial BSIs, comparing 83 episodes in solid organ transplant patients with 2447 BSIs occurring in the general hospital population. Results The prevalence of groups of infecting organisms (gram-positive, gram-negative, and fungi) was similar between transplant patients and the general population and a similar crude mortality rate was observed (34.9% in transplant vs. 43.3% in non-transplant patients). Staphylococcus aureus was the single most frequently isolated organism in both groups, and Acinetobacter species was more frequently isolated in the general population. Regarding MDR organisms, Klebsiella species, and Enterobacter species resistant to cefepime, as well as Acinetobacter species resistant to meropenem, were significantly more frequent in transplant patients. Conclusion Antimicrobial resistance is higher, particularly among gram-negative bacteria in the transplant population, although the overall mortality rate between transplant and non-transplant patients with nosocomial BSI is similar. [ABSTRACT FROM AUTHOR]

Published
2015
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5. Validation of the INCREMENT‐SOT‐CPE score in a large cohort of liver transplant recipients with carbapenem‐resistant Enterobacterales infection

Author

Rinaldi, Matteo, Bonazzetti, Cecilia, Gallo, Mena, Ferraro, Giuseppe, Freire, Maristela, Terrabuio, Débora Raquel Benedita, Tandoi, Francesco, Romagnoli, Renato, De Rosa, Francesco Giuseppe, Mularoni, Alessandra, Ferrarese, Alberto, Burra, Patrizia, Halpern, Marcia, Balbi, Elizabeth, Simkins, Jacques, Abbo, Lilian, Morrás, Ignacio, Cantero, Mireia, Alagna, Laura, Bandera, Alessandra, Clemente, Wanessa Trinidade, Valerio, Maricela, Fernández, Ainhoa, Muñoz, Patricia, Statlender, Liran, Yahav, Dafna, Camargo, Luis Fernando Aranha, Girão, Evelyne Santana, Grossi, Paolo, Viale, Pierluigi, Curti, Stefania, Giannella, Maddalena, Rinaldi M., Bonazzetti C., Gallo M., Ferraro G., Freire M., Terrabuio D.R.B., Tandoi F., Romagnoli R., De Rosa F.G., Mularoni A., Ferrarese A., Burra P., Halpern M., Balbi E., Simkins J., Abbo L., Morrás I., Cantero M., Alagna L., Bandera A., Clemente W.T., Valerio M., Fernández A., Muñoz P., Statlender L., Yahav D., Camargo L.F.A., Girão E.S., Grossi P., Viale P., Curti S., and Giannella M.

Subjects
INCREMENT-SOT-CPE score, Transplantation, Infectious Diseases, CRE infection, liver transplantation, SOT
Abstract

Background: Management of infections due to carbapenemase-resistant Enterobacterales (CRE) in solid organ transplant (SOT) recipients remains a difficult challenge. The INCREMENT-SOT-CPE score has been specifically developed from SOT recipients to stratify mortality risk, but an external validation is lacking.Methods: Multicenter retrospective cohort study of liver transplant (LT) recipients colonized with CRE infection who developed infection after transplant over 7-year period. Primary endpoint was all-cause 30-day mortality from infection onset. A comparison between INCREMENT-SOT-CPE and other selected scores was performed. A two-level mixed effects logistic regression model with random effects for the center was fitted. Performance characteristics at optimal cut-point were calculated. Multivariable Cox regression analysis of risk factors for all-cause 30-day mortality was carried out.Results: Overall, 250 CRE carriers developed infection after LT and were analyzed. The median age was 55 years (interquartile range [IQR]: 46-62) and 157 were males (62.8%). All-cause 30-day mortality was 35.6%. A sequential organ failure assessment (SOFA) score >= 11 showed a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 69.7%, 76.4%, 62.0%, 82.0%, and 74.0%, respectively. An INCREMENT-SOT-CPE >= 11 reported a sensitivity, specificity, PPV, NPV, and accuracy of 73.0%, 62.1%, 51.6%, 80.6% and 66.0%, respectively. At multivariable analysis acute renal failure, prolonged mechanical ventilation, INCREMENT-SOT-CPE score >= 11 and SOFA score >= 11 were independently associated with all-cause 30-day mortality, while a tigecycline-based targeted regimen was found to be protective.Conclusions: Both INCREMENT-SOT-CPE >= 11 and SOFA >= 11 were identified as strong predictors of all-cause 30-day mortality in a large cohort of CRE carriers developing infection after LT.

Published
2023

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