Carbapenem-resistant Enterobacterales in solid organ transplant recipients

Authors

• Angelique E. Boutzoukas, Department of Pediatrics, Duke University, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA.
• Weixiao Dai, The Biostatistics Center, The George Washington University, Rockville, Maryland, USA.
• Eric Cober, Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA.
• Lilian M. Abbo, Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine and Jackson Health System, Miami, Florida, USA.
• Lauren Komarow, The Biostatistics Center, The George Washington University, Rockville, Maryland, USA.
• Liang Chen, Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA.
• Carol Hill, Duke Clinical Research Institute, Durham, North Carolina, USA.
• Michael J. Satlin, Division of Infectious Diseases, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA.
• Matthew Grant, Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
• Bettina C. Fries, Division of Infectious Diseases, Department of Medicine, Stony Brook University, Stony Brook, New York, USA.
• Gopi Patel, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
• Todd P. McCarty, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA.
• Cesar A. Arias, Division of Infectious Diseases, Houston Methodist Hospital, Houston, Texas, USA; Center for Infectious Diseases Research at Houston Methodist Research Institute, Houston, Texas, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA.
• Robert A. Bonomo, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Biochemistry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Case Western Reserve University-Cleveland Veterans Affairs Medical Center for Antimicrobial Resistance and Epidemiology (Case Veterans Affairs Center for Antimicrobial Resistance and Epidemiology), Cleveland, Ohio, USA.
• David van Duin, Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA. Electronic address: David_vanduin@med.unc.edu.

Document Type

Journal Article

Publication Date

11-9-2024

Journal

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

DOI

10.1016/j.ajt.2024.10.020

Keywords

carbapenem-resistant Enterobacterales; epidemiology; mortality; solid organ transplantation

Abstract

Carbapenem-resistant Enterobacterales (CRE) are an important threat to the health of solid organ transplant recipients (SOTr); data comparing outcomes of SOTr with CRE to non-SOTr with CRE are lacking. A matched cohort study was performed within 2 prospective, multicenter, cohort studies (Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacterales and Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacterales 2). The epidemiology, desirability of outcome rankings outcomes, and mortality of SOTr and non-SOTr hospitalized in the United States (December 2011-August 2017) with clinical isolates with Centers for Disease Control and Prevention-defined CRE were compared. In total, 121 SOTr and 242 matched non-SOTr were included. Fifty-one percent of isolates met infection criteria. SOTr were younger (P < .001), less acutely ill (P = .029), less often had a malignancy history (P = .006), and more often were admitted from home (P < .001) than non-SOTr. SOTr had more favorable adjusted desirability of outcome rankings outcomes; a randomly selected SOTr had a 58% (95% confidence interval, 53%-64%) probability of a better outcome as compared to a randomly selected non-SOTr. All-cause 30-day mortality was 14% (17/121) in SOTr vs 25% (60/242) in non-SOTr, P = .018. After stabilized inverse probability weighted adjustment, SOTr had a 7% lower 30-day mortality risk than non-SOTr (95% confidence interval, -15% to 1%). SOTr with CRE do not have worse outcomes than matched patients without transplant history.

APA Citation

Boutzoukas, Angelique E.; Dai, Weixiao; Cober, Eric; Abbo, Lilian M.; Komarow, Lauren; Chen, Liang; Hill, Carol; Satlin, Michael J.; Grant, Matthew; Fries, Bettina C.; Patel, Gopi; McCarty, Todd P.; Arias, Cesar A.; Bonomo, Robert A.; and van Duin, David, "Carbapenem-resistant Enterobacterales in solid organ transplant recipients" (2024). GW Authored Works. Paper 6019.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/6019

Department

Biostatistics and Bioinformatics