Maristela Pinheiro Freire1, Isabel Cristina Villela Soares Oshiro2, Patrícia Rodrigues Bonazzi3, Ligia Câmera Pierrotti4, Larissa Marques de Oliveira5, Anna Silva Machado2, Inneke Marie Van Der Heijdenn5, Flavia Rossi6, Silvia Figueiredo Costa7, Luiz Augusto Carneiro D'Albuquerque3, Edson Abdala8. 1. Infection Control Team, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil. Electronic address: maristelapf@uol.com.br. 2. Infection Control Team, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil. 3. Liver and Intestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil. 4. Department of Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil. 5. Microbiology Research Laboratory-LIM54, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil. 6. Microbiology Laboratory, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil. 7. Department of Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil; Microbiology Research Laboratory-LIM54, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil. 8. Liver and Intestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil; Department of Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil.
Abstract
BACKGROUND: The prevalence of infection with multidrug-resistant gram-negative bacteria (MDR-GNB) after solid-organ transplantation is increasing. Surveillance culture (SC) seems to be an important tool for MDR-GNB control. The goal of this study was to analyze the performance of SC for MDR-GNB among liver transplant (LT) recipients. METHODS: This was a prospective cohort study involving patients who underwent LT between November 2009 and November 2011. We screened patients for extended spectrum β-lactamase-producing Escherichia coli, extended spectrum β-lactamase-producing Klebsiella pneumoniae, and carbapenem-resistant Enterobacteriaceae, carbapenem-resistant Pseudomonas aeruginosa (CRPA), and carbapenem-resistant Acinetobacter baumannii (CRAB). We collected SC samples immediately before LT and weekly thereafter, until hospital discharge. Samples were collected from the inguinal-rectal area, axilla, and throat. The performance of SC was evaluated through analysis of its sensitivity, negative predictive value, and accuracy. RESULTS: During the study period, 181 patients were evaluated and 4,110 SC samples were collected. The GNB most often identified was CRAB, in 45.9% of patients, followed by CRKP in 40.3%. For all microorganisms, the positivity rate was highest among the inguinal-rectal samples. If only samples collected from this area were considered, the SC would fail to identify 34.9% of the cases of CRAB colonization. The sensitivity of SC for CRKP was 92.5%. The performance of SC was poorest for CRAB (sensitivity, 80.6%). CONCLUSIONS: Our data indicate that SC is a sensitive tool to identify LT recipients colonized by MDR-GNB.
BACKGROUND: The prevalence of infection with multidrug-resistant gram-negative bacteria (MDR-GNB) after solid-organ transplantation is increasing. Surveillance culture (SC) seems to be an important tool for MDR-GNB control. The goal of this study was to analyze the performance of SC for MDR-GNB among liver transplant (LT) recipients. METHODS: This was a prospective cohort study involving patients who underwent LT between November 2009 and November 2011. We screened patients for extended spectrum β-lactamase-producing Escherichia coli, extended spectrum β-lactamase-producing Klebsiella pneumoniae, and carbapenem-resistant Enterobacteriaceae, carbapenem-resistant Pseudomonas aeruginosa (CRPA), and carbapenem-resistant Acinetobacter baumannii (CRAB). We collected SC samples immediately before LT and weekly thereafter, until hospital discharge. Samples were collected from the inguinal-rectal area, axilla, and throat. The performance of SC was evaluated through analysis of its sensitivity, negative predictive value, and accuracy. RESULTS: During the study period, 181 patients were evaluated and 4,110 SC samples were collected. The GNB most often identified was CRAB, in 45.9% of patients, followed by CRKP in 40.3%. For all microorganisms, the positivity rate was highest among the inguinal-rectal samples. If only samples collected from this area were considered, the SC would fail to identify 34.9% of the cases of CRAB colonization. The sensitivity of SC for CRKP was 92.5%. The performance of SC was poorest for CRAB (sensitivity, 80.6%). CONCLUSIONS: Our data indicate that SC is a sensitive tool to identify LT recipients colonized by MDR-GNB.
Authors: Marta Fernández-Martínez; Claudia González-Rico; Luis Martínez-Martínez; Maria Carmen Fariñas; Mónica Gozalo-Margüello; Francesc Marco; Irene Gracia-Ahufinger; Maitane Aranzamendi; Ana M Sánchez-Díaz; Teresa Vicente-Rangel; Fernando Chaves; Jorge Calvo Montes Journal: Sci Rep Date: 2021-06-04 Impact factor: 4.379