Carbapenem-resistant gram-negative rod bacteremia in the early postoperative period following liver transplantation

Abstract

Background: Carbapenem-resistant gram-negative rod bacteremia (CRGNR-B) is emerging as a formidable challenge, complicating patient management and outcomes in liver transplantation (LT). This study aimed to investigate the incidence, mortality, and risk factors associated with CRGNR-B within 90 days following LT.

Methods: A retrospective nested case-control study was conducted using single centric LT data (n=1,379). CRGNR-B cases were matched 1:5 with control patients for analyzing survival and risk factors for CRGNR-B.

Results: The incidence of CRGNR-B within 90 days post-LT was 6.5% (n=87). The CRGNR-B group showed significantly lower 1-year post-LT survival compared to the control group (37.9% vs. 90.0%, p<0.001). CRGNR-B was significantly correlated with increased mortality after adjustment of covariates (adjusted hazard ratio, 5.66; 95% confidence interval [CI], 3.89–8.24; p<0.001). Key risk factors identified include higher pretransplant model for end-stage liver disease scores (odds ratio [OR], 1.05; 95% CI, 1.01–1.09; p=0.006), encephalopathy prior to transplant (OR, 2.79; 95% CI, 1.48–5.30; p=0.002), retransplantation (OR, 10.4; 95% CI, 2.79–42.1; p<0.001), each 60-minute increase in cold ischemic time (OR, 1.20; 95% CI, 1.01–1.42; p=0.037), and bile duct complications (OR, 6.16; 95% CI, 2.66–14.2; p<0.001).

Conclusion: The occurrence of CRGNR-B within 90 days post-LT poses a significant risk to patient survival, with identifiable pre- and peri-transplant risk factors. These findings underscore the importance of targeted preventive measures, early detection, and effective management strategies to enhance outcomes for LT recipients.