Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 22 , ISSUE 4 ( 2018 ) > List of Articles

BRIEF COMMUNICATION

Epidemiological analysis of extended-spectrum beta-lactamase-producing bacterial infections in adult live donor liver transplant patients

Anand Gupta, Usha Baveja, Neha Tandon, Sweta Patel, Sanjiv Saigal, Arvinder Soin

Keywords : Extended-spectrum beta-lactamases, Klebsiella, liver transplant recipients

Citation Information : Gupta A, Baveja U, Tandon N, Patel S, Saigal S, Soin A. Epidemiological analysis of extended-spectrum beta-lactamase-producing bacterial infections in adult live donor liver transplant patients. Indian J Crit Care Med 2018; 22 (4):290-296.

DOI: 10.4103/ijccm.IJCCM_206_17

License: CC BY-ND 3.0

Published Online: 00-04-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Bacterial infections are a leading cause of morbidity and mortality in patients receiving solid-organ transplants. Extended-spectrum beta-lactamases (ESBL) pathogens are the most important pathogenic bacteria infecting these patients. Aim: This study aims to evaluate for the incidence and characteristics of ESBL-positive organism, to look for the clinical outcomes in ESBL-positive infected cases, and to evaluate and draft the antibiotic policy in posttransplant patients during the first 28 days posttransplant. Materials and Methods: This is a retrospective data analysis of liver transplant recipients infected with ESBL culture-positive infections. All the culture sites such as blood, urine, and endotracheal tube aspirates were screened for the first ESBL infection they had and noted. This data were collected till day 28 posttransplant. The antibiotic susceptibility pattern and the most common organism were also noted. Results: A total of 484 patients was screened and 116 patients had ESBL-positive cultures. Out of these, 54 patients had infections and 62 patients were ESBL colonizers. The primary infection site was abdominal fluid (40.7%), with Klebsiella accounting for most of the ESBL infections. Colistin was the most sensitive antibiotic followed by tigecycline. The overall mortality was 11.4% and 31 out of 54 ESBL-infected patients died. Conclusions: Infections with ESBL-producing organism in liver transplant recipients has a high mortality and very limited therapeutic options.


PDF Share
  1. Snyder JJ, Israni AK, Peng Y, Zhang L, Simon TA, Kasiske BL, et al. Rates of first infection following kidney transplant in the United States. Kidney Int 2009;75:317-26.
  2. Losada I, Cuervas-Mons V, Millán I, Dámaso D. Early infection in liver transplant recipients: Incidence, severity, risk factors and antibiotic sensitivity of bacterial isolates. Enferm Infecc Microbiol Clin 2002;20:422-30.
  3. Kusne S, Dummer JS, Singh N, Iwatsuki S, Makowka L, Esquivel C, et al. Infections after liver transplantation. An analysis of 101 consecutive cases. Medicine (Baltimore) 1988;67:132-43.
  4. Aberg F, Mäkisalo H, Höckerstedt K, Isoniemi H. Infectious complications more than 1 year after liver transplantation: A 3-decade nationwide experience. Am J Transplant 2011;11:287-95.
  5. Du B, Long Y, Liu H, Chen D, Liu D, Xu Y, et al. Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae bloodstream infection: Risk factors and clinical outcome. Intensive Care Med 2002;28:1718-23.
  6. Paterson DL, Bonomo RA. Extended-spectrum beta-lactamases: A clinical update. Clin Microbiol Rev 2005;18:657-86.
  7. Winters HA, Parbhoo RK, Schafer JJ, Goff DA. Extended-spectrum beta-lactamase-producing bacterial infections in adult solid organ transplant recipients. Ann Pharmacother 2011;45:309-16.
  8. Avkan-Oguz V, Ozkardesler S, Unek T, Ozbilgin M, Akan M, Firuzan E, et al. Risk factors for early bacterial infections in liver transplantation. Transplant Proc 2013;45:993-7.
  9. Freire MP, Soares Oshiro IC, Bonazzi PR, Guimarães T, Ramos Figueira ER, Bacchella T, et al. Surgical site infections in liver transplant recipients in the model for end-stage liver disease era: An analysis of the epidemiology, risk factors, and outcomes. Liver Transpl 2013;19:1011-9.
  10. Li C, Wen TF, Mi K, Wang C, Yan LN, Li B, et al. Analysis of infections in the first 3-month after living donor liver transplantation. World J Gastroenterol 2012;18:1975-80.
  11. Nafady-Hego H, Elgendy H, Moghazy WE, Fukuda K, Uemoto S. Pattern of bacterial and fungal infections in the first 3 months after pediatric living donor liver transplantation: An 11-year single-center experience. Liver Transpl 2011;17:976-84.
  12. Iida T, Kaido T, Yagi S, Yoshizawa A, Hata K, Mizumoto M, et al. Posttransplant bacteremia in adult living donor liver transplant recipients. Liver Transpl 2010;16:1379-85.
  13. Reid GE, Grim SA, Sankary H, Benedetti E, Oberholzer J, Clark NM, et al. Early intra-abdominal infections associated with orthotopic liver transplantation. Transplantation 2009;87:1706-11.
  14. Hashimoto M, Sugawara Y, Tamura S, Kaneko J, Matsui Y, Kokudo N, et al. Pseudomonas aeruginosa infection after living-donor liver transplantation in adults. Transpl Infect Dis 2009;11:11-9.
  15. Asensio A, Ramos A, Cuervas-Mons V, Cordero E, Sánchez-Turrión V, Blanes M, et al. Effect of antibiotic prophylaxis on the risk of surgical site infection in orthotopic liver transplant. Liver Transpl 2008;14:799-805.
  16. Said A, Safdar N, Lucey MR, Knechtle SJ, D'Alessandro A, Musat A, et al. Infected bilomas in liver transplant recipients, incidence, risk factors and implications for prevention. Am J Transplant 2004;4:574-82.
  17. Kalpoe JS, Sonnenberg E, Factor SH, del Rio Martin J, Schiano T, Patel G, et al. Mortality associated with carbapenem-resistant Klebsiella pneumoniae infections in liver transplant recipients. Liver Transpl 2012;18:468-74.
  18. Shields RK, Clancy CJ, Gillis LM, Kwak EJ, Silveira FP, Massih RC, et al. Epidemiology, clinical characteristics and outcomes of extensively drug-resistant Acinetobacter baumannii infections among solid organ transplant recipients. PLoS One 2012;7:e52349.
  19. Gearhart M, Martin J, Rudich S, Thomas M, Wetzel D, Solomkin J, et al. Consequences of vancomycin-resistant Enterococcus in liver transplant recipients: A matched control study. Clin Transplant 2005;19:711-6.
  20. Orloff SL, Busch AM, Olyaei AJ, Corless CL, Benner KG, Flora KD, et al. Vancomycin-resistant Enterococcus in liver transplant patients. Am J Surg 1999;177:418-22.
  21. Newell KA, Millis JM, Arnow PM, Bruce DS, Woodle ES, Cronin DC, et al. Incidence and outcome of infection by vancomycin-resistant enterococcus following orthotopic liver transplantation. Transplantation 1998;65:439-42.
  22. de Gouvêa EF, Martins IS, Halpern M, Ferreira AL, Basto ST, Gonçalves RT, et al. The influence of carbapenem resistance on mortality in solid organ transplant recipients with Acinetobacter baumannii infection. BMC Infect Dis 2012;12:351.
  23. Shi SH, Kong HS, Jia CK, Zhang WJ, Xu J, Wang WL, et al. Risk factors for pneumonia caused by multidrug-resistant gram-negative bacilli among liver recipients. Clin Transplant 2010;24:758-65.
  24. Kim YJ, Yoon JH, Kim SI, Hong KW, Kim JI, Choi JY, et al. High mortality associated with Acinetobacter species infection in liver transplant patients. Transplant Proc 2011;43:2397-9.
  25. Giannella M, Bartoletti M, Morelli MC, Tedeschi S, Cristini F, Tumietto F, et al. Risk factors for infection with carbapenem-resistant Klebsiella pneumoniae after liver transplantation: The importance of pre- and posttransplant colonization. Am J Transplant 2015;15:1708-15.
  26. Porwal R, Gopalakrishnan R, Rajesh NJ, Ramasubramanian V. Carbapenem resistant gram-negative bacteremia in an Indian intensive care unit: A review of the clinical profile and treatment outcome of 50 patients. Indian J Crit Care Med 2014;18:750-3.
  27. Bergamasco MD, Barroso Barbosa M, de Oliveira Garcia D, Cipullo R, Moreira JC, Baia C, et al. Infection with Klebsiella pneumoniae carbapenemase (KPC)-producing K. Pneumoniae in solid organ transplantation. Transpl Infect Dis 2012;14:198-205.
  28. Mouloudi E, Massa E, Papadopoulos S, Iosifidis E, Roilides I, Theodoridou T, et al. Bloodstream infections caused by carbapenemase-producing Klebsiella pneumoniae among intensive care unit patients after orthotopic liver transplantation: Risk factors for infection and impact of resistance on outcomes. Transplant Proc 2014;46:3216-8.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.