Carbapenem-resistant Enterobacteriaceae among kidney transplant recipients - insights on the risk of acquisition and CRE infection

Imagem de Miniatura
Arquivos
art_FREIRE_Carbapenemresistant_Enterobacteriaceae_among_kidney_transplant_recipients_insights_on_2021.PDF (1.45 MB)
Citações na Scopus
9
Tipo de produção
article
Data de publicação
2021
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
TAYLOR & FRANCIS LTD
Autores
Citação
INFECTIOUS DISEASES, v.53, n.6, p.430-439, 2021
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background Kidney transplant recipients are a risk group for carbapenem-resistant Enterobacteriaceae infection. Objectives This study aimed to identify risk factors for CRE acquisition and infection among kidney transplant recipients. Methods We conducted a case-control study; we defined the case as kidney transplant recipient with positive culture for carbapenem-resistant Enterobacteriaceae identified between January 2010 and February 2019. Controls were chosen among kidney transplant recipients hospitalized in the same period of cases (1:2). Surveillance culture for carbapenem-resistant Enterobacteriaceae was performed at admission and weekly during hospital stay. The risk factors analysis for carbapenem-resistant Enterobacteriaceae infection was performed among patients colonized by these bacteria. Results We identified 331 patients colonized with carbapenem-resistant Enterobacteriaceae; The median time from transplantation to first carbapenem-resistant Enterobacteriaceae positive culture was 42 days (range from 3 to 7399 days); 125(37.8%) patients developed infection; the most common site was urinary tract. Risk factors for carbapenem-resistant Enterobacteriaceae acquisition were recipient age >45-year, diabetes nephropathy, donor age >55-year, ureteral stent at kidney transplantation, delay of graft function, median lymphocytes count <800cells/mm(3), and acute cellular rejection. Risk factors for carbapenem-resistant Enterobacteriaceae infection were recipient age at CRE acquisition >50-year; median lymphocytes count <= 700 cells/mm(3), carbapenem use, and colonization by polymyxin-resistant strain. Patients colonized by polymyxin and carbapenem resistant Enterobacteriaceae strain who used carbapenem had a 93.8% probability of developing infection by this agent. Conclusion Carbapenem-resistant Enterobacteriaceae acquisition after kidney transplant is related to graft conditions, immunosuppression degree. Among carbapenem-resistant Enterobacteriaceae colonized patients, special attention is needed for those harbouring polymyxin-resistant strains.
Palavras-chave
Polymyxin resistance, delay of graft function, urinary tract infection, lymphopenia, diabetes nephropathy, rejection
URI
https://observatorio.fm.usp.br/handle/OPI/40495
Referências
  1. Aguado JM, 2018, TRANSPLANT REV-ORLAN, V32, P36, DOI 10.1016/j.trre.2017.07.001
  2. Cicora F, 2013, TRANSPL P, V45, P3389, DOI 10.1016/j.transproceed.2013.07.064
  3. CLSI, 2017, M100 CLSI, P282
  4. EUCAST, 2018, EUR COMM ANT SUSC TE
  5. Freire MP, 2019, EUR J CLIN MICROBIOL, V38, P755, DOI 10.1007/s10096-019-03468-4
  6. Freire MP, 2015, INFECTION, V43, P315, DOI 10.1007/s15010-015-0743-4
  7. Freire MP, 2018, TRANSPL INFECT DIS, V20, DOI 10.1111/tid.12923
  8. Freire MP, 2017, TRANSPLANTATION, V101, P811, DOI [10.1097/tp.0000000000001620, 10.1097/TP.0000000000001620]
  9. Freire MP, 2016, J ANTIMICROB CHEMOTH, V71, P2577, DOI 10.1093/jac/dkw165
  10. Giannella M, 2019, CLIN MICROBIOL INFEC, V25, P1525, DOI 10.1016/j.cmi.2019.04.014
  11. Gutierrez-Gutierrez Belen, 2017, Lancet Infect Dis, V17, P726, DOI 10.1016/S1473-3099(17)30228-1
  12. Huprikar, 2017, CDC NHSN SURVEILLANC
  13. Huprikar S, 2016, AM J TRANSPLANT, V16, P403
  14. Macesic N, 2018, CLIN INFECT DIS, V67, P905, DOI 10.1093/cid/ciy199
  15. Mularoni A, 2019, TRANSPL INFECT DIS, V21, DOI 10.1111/tid.13119
  16. Neff RT, 2009, TRANSPLANTATION, V88, P135, DOI 10.1097/TP.0b013e3181aad256
  17. Perez E, 2020, AGING MENT HEALTH, V24, P1459, DOI 10.1080/13607863.2019.1663492
  18. Pouch SM, 2017, VIRULENCE, V8, P391, DOI 10.1080/21505594.2016.1213472
  19. dos Santos BGR, 2016, TRANSPL P, V48, P2050, DOI 10.1016/j.transproceed.2016.05.005
  20. San-Juan R, 2020, J INFECT DIS, V222, P479, DOI 10.1093/infdis/jiaa090
  21. Simkins J, 2014, TRANSPL INFECT DIS, V16, P775, DOI 10.1111/tid.12276
  22. Varotti G, 2017, TRANSPL INFECT DIS, V19, DOI 10.1111/tid.12757
  23. Wu XH, 2016, AM J INFECT CONTROL, V44, P1261, DOI 10.1016/j.ajic.2016.04.222
  24. Zhang, 2018, EMERG MICROBES INFEC, V7, P111
  25. Zimmerman FS, 2013, AM J INFECT CONTROL, V41, P190, DOI 10.1016/j.ajic.2012.09.020

Coleções
Artigos e Materiais de Revistas Científicas - FM/MCG
Artigos e Materiais de Revistas Científicas - HC/ICESP
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - LIM/47
Artigos e Materiais de Revistas Científicas - LIM/55
Artigos e Materiais de Revistas Científicas - ODS/03