Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy.
Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy.
Clin Microbiol Infect. 2019 Dec;25(12):1525-1531. doi: 10.1016/j.cmi.2019.04.014. Epub 2019 Apr 27.
To investigate the impact of colonization with carbapenemase-producing Enterobacteriaceae (CPE) on the CPE infection risk after liver transplantation (LT).
Prospective cohort study of all adult patients undergoing LT at our centre over an 8-year period (2010-2017). Individuals were screened for CPE colonization by rectal swabs at inclusion onto the waiting list, immediately before LT and weekly after LT until hospital discharge. Asymptomatic carriers did not receive decolonization, anti-CPE prophylaxis or pre-emptive antibiotic therapy. Participants were followed up for 1 year after LT.
We analysed 553 individuals who underwent a first LT, 38 were colonized with CPE at LT and 104 acquired colonization after LT. CPE colonization rates at LT and acquired after LT increased significantly over the study period: incidence rate ratios (IRR) 1.21 (95% CI 1.05-1.39) and 1.17 (95% CI 1.07-1.27), respectively. Overall, 57 patients developed CPE infection within a median of 31 (interquartile range 11-115) days after LT, with an incidence of 3.05 cases per 10 000 LT-recipient-days and a non-significant increase over the study period (IRR 1.11, 95% CI 0.98-1.26). In multivariable analysis, CPE colonization at LT (hazard ratio (HR) 18.50, 95% CI 6.76-50.54) and CPE colonization acquired after LT (HR 16.89, 95% CI 6.95-41.00) were the strongest risk factors for CPE infection, along with combined transplant (HR 2.60, 95% CI 1.20-5.59), higher Model for End-Stage Liver Disease at the time of LT (HR 1.03, 95% CI 1.00-1.07), prolonged mechanical ventilation (HR 2.63, 95% CI 1.48-4.67), re-intervention (HR 2.16, 95% CI 1.21-3.84) and rejection (HR 2.81, 95% CI 1.52-5.21).
CPE colonization at LT or acquired after LT were the strongest predictors of CPE infection. Prevention strategies focused on LT candidates and recipients colonized with CPE should be investigated.
研究产碳青霉烯酶肠杆菌科（CPE）定植对肝移植（LT）后 CPE 感染风险的影响。
对本中心 8 年期间（2010-2017 年）所有接受 LT 的成年患者进行前瞻性队列研究。将纳入等候名单的个体进行直肠拭子筛查，以确定是否存在 CPE 定植，LT 前、LT 后每周进行筛查，直至出院。无症状携带者不接受去定植、抗 CPE 预防或抢先抗生素治疗。对参与者进行 LT 后 1 年的随访。
我们分析了 553 名接受首次 LT 的患者，其中 38 名在 LT 时定植了 CPE，104 名在 LT 后定植。LT 时和 LT 后获得的 CPE 定植率在研究期间显著增加：发病率比值比（IRR）分别为 1.21（95%CI 1.05-1.39）和 1.17（95%CI 1.07-1.27）。总体而言，57 名患者在 LT 后中位 31（四分位距 11-115）天内发生了 CPE 感染，每 10000 LT 受者-天的发病率为 3.05 例，在研究期间无显著增加（IRR 1.11，95%CI 0.98-1.26）。多变量分析显示，LT 时的 CPE 定植（危险比（HR）18.50，95%CI 6.76-50.54）和 LT 后获得的 CPE 定植（HR 16.89，95%CI 6.95-41.00）是 CPE 感染的最强危险因素，此外还有联合移植（HR 2.60，95%CI 1.20-5.59）、LT 时更高的终末期肝病模型（HR 1.03，95%CI 1.00-1.07）、机械通气延长（HR 2.63，95%CI 1.48-4.67）、再次干预（HR 2.16，95%CI 1.21-3.84）和排斥（HR 2.81，95%CI 1.52-5.21）。
LT 时的 CPE 定植或 LT 后获得的定植是 CPE 感染的最强预测因子。应研究针对 LT 候选人和定植 CPE 的受者的预防策略。
