Multidrug-resistant bacterial infections after liver transplantation: Prevalence, impact, and risk factors

Infections by multidrug-resistant bacteria (MDRB) are an increasing healthcare problem worldwide. This study analyzes the incidence, burden, and risk factors associated with MDRB infections after liver transplant(ation) (LT). This retrospective, multicenter cohort study included adult patients who u...

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Published in:Journal of hepatology 2024-06, Vol.80 (6), p.904-912
Main Authors: Martin-Mateos, Rosa, Martínez-Arenas, Laura, Carvalho-Gomes, Ángela, Aceituno, Laia, Cadahía, Valle, Salcedo, Magdalena, Arias, Ana, Pérez, Sara Lorente, Odriozola, Aitor, Zamora, Javier, Blanes, Marino, Len, Óscar, Benítez, Laura, Campos-Varela, Isabel, González-Diéguez, María Luisa, Lázaro, Diego Rojo, Fortún, Jesús, Cuadrado, Antonio, Carrasco, Natalia Marcos, Rodríguez-Perálvarez, Manuel, Álvarez-Navascues, Carmen, Fábrega, Emilio, Serrano, Trinidad, Cuervas-Mons, Valentín, Rodríguez, Manuel, Castells, Lluis, Berenguer, Marina, Graus, Javier, Albillos, Agustín
Format: Article
Language:English
Subjects:
Aged
Anti-Bacterial Agents - therapeutic use
Bacterial Infections - epidemiology
Bacterial Infections - etiology
cirrhosis
Drug Resistance, Multiple, Bacterial
Enterococcus faecium - isolation & purification
Female
Humans
Incidence
infections
liver transplant
Liver Transplantation - adverse effects
Male
Middle Aged
multidrug-resistant bacteria
Postoperative Complications - epidemiology
Postoperative Complications - microbiology
Prevalence
Retrospective Studies
Risk Factors
Spain - epidemiology
Urinary Tract Infections - epidemiology
Urinary Tract Infections - etiology
Urinary Tract Infections - microbiology
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Summary:Infections by multidrug-resistant bacteria (MDRB) are an increasing healthcare problem worldwide. This study analyzes the incidence, burden, and risk factors associated with MDRB infections after liver transplant(ation) (LT). This retrospective, multicenter cohort study included adult patients who underwent LT between January 2017 and January 2020. Risk factors related to pre-LT disease, surgical procedure, and postoperative stay were analyzed. Multivariate logistic regression analysis was performed to identify independent predictors of MDRB infections within the first 90 days after LT. We included 1,045 LT procedures (960 patients) performed at nine centers across Spain. The mean age of our cohort was 56.8 ± 9.3 years; 75.4% (n = 782) were male. Alcohol-related liver disease was the most prevalent underlying etiology (43.2.%, n = 451). Bacterial infections occurred in 432 patients (41.3%) who presented with a total of 679 episodes of infection (respiratory infections, 19.3%; urinary tract infections, 18.5%; bacteremia, 13.2% and cholangitis 11%, among others). MDRB were isolated in 227 LT cases (21.7%) (348 episodes). Enterococcus faecium (22.1%), Escherichia coli (18.4%), and Pseudomonas aeruginosa (15.2%) were the most frequently isolated microorganisms. In multivariate analysis, previous intensive care unit admission (0-3 months before LT), previous MDRB infections (0-3 months before LT), and an increasing number of packed red blood cell units transfused during surgery were identified as independent predictors of MDRB infections. Mortality at 30, 90, 180, and 365 days was significantly higher in patients with MDRB isolates. MDRB infections are highly prevalent after LT and have a significant impact on prognosis. Enterococcus faecium is the most frequently isolated multi-resistant microorganism. New pharmacological and surveillance strategies aimed at preventing MDRB infections after LT should be considered for patients with risk factors. Multidrug-resistant bacterial infections have a deep impact on morbidity and mortality after liver transplantation. Strategies aimed at improving prophylaxis, early identification, and empirical treatment are paramount. Our study unveiled the prevalence and main risk factors associated with these infections, and demonstrated that gram-positive bacteria, particularly Enterococcus faecium, are frequent in this clinical scenario. These findings provide valuable insights for the development of prophylactic and empirical an
ISSN:0168-8278
1600-0641
1600-0641
DOI:10.1016/j.jhep.2024.02.023