Di Wu1, Chunmei Chen2, Taohua Liu3, Yan Jia1, Qiquan Wan4, Jie Peng5. 1. Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, Hunan, China. 2. Department of Pediatrics, the Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, Guangdong, China. 3. Transplantation Center, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China. 4. Transplantation Center, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China. 13548685542@163.com. 5. Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, Hunan, China. pengjie2014@csu.edu.cn.
Abstract
INTRODUCTION: Carbapenem-resistant gram-negative bacteria (CR-GNB) can cause life-threatening infections among abdominal solid organ transplantation (ASOT) recipients. This study aimed to investigate the epidemiology and drug susceptibility of CR-GNB pathogens and identity the risk factors associated with 90-day crude mortality of CR-GNB infections among ASOT recipients. METHODS: We retrospectively reviewed the clinical characteristics, drug resistance rate, and risk factors associated with mortality in CR-GNB infections among ASOT recipients between August 1, 2013, and August 1, 2020. The Cox regression model was performed to identify the independent risk factors for mortality. RESULTS: During the 8-year period, CR-GNB infections occurred in 153 of 1452 (10.5%) recipients, and 23 of 153 (15.0%) patients died. The most common pathogen was Acinetobacter baumannii (n = 47). The drug resistance rate of CR-GNB pathogens was relatively low to tigecycline (33.3%) and high to other categories (> 60%). There was a significant increasing trend in drug resistance to tigecycline as time went on (from 24 to 40%, P = 0.04). The independent risk factors for mortality were mechanical ventilation (hazard ratio 7.40, 95% confidence interval 2.69-20.38, P < 0.001), septic shock (hazard ratio 7.41, 95% confidence interval 2.86-19.23, P < 0.001), and platelet count < 50,000/mm3 (hazard ratio 4.00, 95% confidence interval 1.49-10.76, P = 0.006). CONCLUSION: CR-GNB is widespread with high prevalence and mortality rates among ASOT recipients. Mechanical ventilation, septic shock, and low platelet count represent three independent risk factors related to the mortality of ASOT recipients with CR-GNB infection. We suggest that tigecycline may be used under rigorous management because of the significant increasing risk of drug resistance.
INTRODUCTION:Carbapenem-resistant gram-negative bacteria (CR-GNB) can cause life-threatening infections among abdominal solid organ transplantation (ASOT) recipients. This study aimed to investigate the epidemiology and drug susceptibility of CR-GNB pathogens and identity the risk factors associated with 90-day crude mortality of CR-GNB infections among ASOT recipients. METHODS: We retrospectively reviewed the clinical characteristics, drug resistance rate, and risk factors associated with mortality in CR-GNB infections among ASOT recipients between August 1, 2013, and August 1, 2020. The Cox regression model was performed to identify the independent risk factors for mortality. RESULTS: During the 8-year period, CR-GNB infections occurred in 153 of 1452 (10.5%) recipients, and 23 of 153 (15.0%) patientsdied. The most common pathogen was Acinetobacter baumannii (n = 47). The drug resistance rate of CR-GNB pathogens was relatively low to tigecycline (33.3%) and high to other categories (> 60%). There was a significant increasing trend in drug resistance to tigecycline as time went on (from 24 to 40%, P = 0.04). The independent risk factors for mortality were mechanical ventilation (hazard ratio 7.40, 95% confidence interval 2.69-20.38, P < 0.001), septic shock (hazard ratio 7.41, 95% confidence interval 2.86-19.23, P < 0.001), and platelet count < 50,000/mm3 (hazard ratio 4.00, 95% confidence interval 1.49-10.76, P = 0.006). CONCLUSION:CR-GNB is widespread with high prevalence and mortality rates among ASOT recipients. Mechanical ventilation, septic shock, and low platelet count represent three independent risk factors related to the mortality of ASOT recipients with CR-GNB infection. We suggest that tigecycline may be used under rigorous management because of the significant increasing risk of drug resistance.
Entities:
Keywords:
Abdominal solid organ transplant; Carbapenem-resistant; Drug resistance rate; Mortality; Risk factor