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Acquisition of Carbapenemase-Producing Enterobacteriaceae in Solid Organ Transplantation Recipients

 K.H. Lee  ;  S.H. Han  ;  D. Yong  ;  H.C. Paik  ;  J.G. Lee  ;  M.S. Kim  ;  D.J. Joo  ;  J.S. Choi  ;  S.I. Kim  ;  Y.S. Kim  ;  M.S. Park  ;  S.Y. Kim  ;  Y.N. Yoon  ;  S. Kang  ;  S.J. Jeong  ;  J.Y. Choi  ;  Y.G. Song  ;  J.M. Kim 
 TRANSPLANTATION PROCEEDINGS, Vol.50(10) : 3748-3755, 2018 
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BACKGROUND: Carbapenemase-producing Enterobacteriaceae (CPE) can lead to life-threatening outcomes with rapid spread of the carbapenemase gene in solid organ transplantation (SOT) recipients because of limitations of available antibiotics. We examined the characteristics and importance of CPE acquisition in SOT recipients with large numbers of CPE isolates.

METHODS: Between November 2015 and October 2016, 584 CPE isolates were found in 37 recipients and verified by carbapenemase gene multiplex polymerase chain reaction (PCR). One hundred recipients with at least 2 negative results in carbapenemase PCR for stool surveillance and no CPE isolates in clinical samples were retrospectively included.

RESULTS: Most CPE isolates were Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (546, 93.5%). The most frequent transplantation organ was lung (43.3%), and the most common sample with CPE isolates other than stool was respiratory tract (22.6%). The median time between SOT and first CPE acquisition was 7 days. All-cause mortality was significantly higher in recipients with CPE than in those without CPE (24.3% vs 10.0%; P = .03). In multivariate regression analysis, stool colonization of vancomycin-resistant Enterococci and/or Clostridium difficile during 30 days before SOT (odds ratio [OR], 3.28; 95% CI, 1.24-8.68; P = .02), lung transplantation (OR, 4.50; 95% CI, 1.19-17.03; P = .03), and intensive care unit stay ≥2 weeks (OR, 6.21; 95% CI, 1.72-22.45; P = .005) were associated with acquisition of CPE.

CONCLUSIONS: Early posttransplantation CPE acquisition may affect the clinical outcome of SOT recipients. Careful screening for CPE during the early posttransplantation period would be meaningful in recipients with risk factors.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Song, Young Goo(송영구) ORCID logo https://orcid.org/0000-0002-0733-4156
Lee, Kyoung Hwa(이경화) ORCID logo https://orcid.org/0000-0003-0033-1398
Han, Sang Hoon(한상훈) ORCID logo https://orcid.org/0000-0002-4278-5198
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