Acquisition of Carbapenemase-Producing Enterobacteriaceae in Solid Organ Transplantation Recipients

K. H. Lee, S. H. Han, D. Yong, H. C. Paik, JaeGil Lee, M. S. Kim, D. J. Joo, J. S. Choi, S. I. Kim, Y. S. Kim, M. S. Park, S. Y. Kim, Y. N. Yoon, S. Kang, S. J. Jeong, J. Y. Choi, Y. G. Song, J. M. Kim

Research output: Contribution to journalArticle

Abstract

Background: Carbapenemase-producing Enterobacteriaceae (CPE) can lead to life-threatening outcomes with rapid spread of the carbapenemase gene in solid organ transplantation (SOT) recipients because of limitations of available antibiotics. We examined the characteristics and importance of CPE acquisition in SOT recipients with large numbers of CPE isolates. Methods: Between November 2015 and October 2016, 584 CPE isolates were found in 37 recipients and verified by carbapenemase gene multiplex polymerase chain reaction (PCR). One hundred recipients with at least 2 negative results in carbapenemase PCR for stool surveillance and no CPE isolates in clinical samples were retrospectively included. Results: Most CPE isolates were Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (546, 93.5%). The most frequent transplantation organ was lung (43.3%), and the most common sample with CPE isolates other than stool was respiratory tract (22.6%). The median time between SOT and first CPE acquisition was 7 days. All-cause mortality was significantly higher in recipients with CPE than in those without CPE (24.3% vs 10.0%; P =.03). In multivariate regression analysis, stool colonization of vancomycin-resistant Enterococci and/or Clostridium difficile during 30 days before SOT (odds ratio [OR], 3.28; 95% CI, 1.24–8.68; P =.02), lung transplantation (OR, 4.50; 95% CI, 1.19–17.03; P =.03), and intensive care unit stay ≥2 weeks (OR, 6.21; 95% CI, 1.72–22.45; P =.005) were associated with acquisition of CPE. Conclusions: Early posttransplantation CPE acquisition may affect the clinical outcome of SOT recipients. Careful screening for CPE during the early posttransplantation period would be meaningful in recipients with risk factors.

Original languageEnglish
Pages (from-to)3748-3755
Number of pages8
JournalTransplantation Proceedings
Volume50
Issue number10
DOIs
Publication statusPublished - 2018 Dec 1

Fingerprint

Organ Transplantation
Enterobacteriaceae
carbapenemase
Odds Ratio
Klebsiella pneumoniae
Clostridium difficile
Lung Transplantation
Multiplex Polymerase Chain Reaction
Respiratory System
Genes

All Science Journal Classification (ASJC) codes

  • Surgery
  • Transplantation

Cite this

Lee, K. H. ; Han, S. H. ; Yong, D. ; Paik, H. C. ; Lee, JaeGil ; Kim, M. S. ; Joo, D. J. ; Choi, J. S. ; Kim, S. I. ; Kim, Y. S. ; Park, M. S. ; Kim, S. Y. ; Yoon, Y. N. ; Kang, S. ; Jeong, S. J. ; Choi, J. Y. ; Song, Y. G. ; Kim, J. M. / Acquisition of Carbapenemase-Producing Enterobacteriaceae in Solid Organ Transplantation Recipients. In: Transplantation Proceedings. 2018 ; Vol. 50, No. 10. pp. 3748-3755.
@article{dfacaf16e0794162abb2817023ed1b8e,
title = "Acquisition of Carbapenemase-Producing Enterobacteriaceae in Solid Organ Transplantation Recipients",
abstract = "Background: Carbapenemase-producing Enterobacteriaceae (CPE) can lead to life-threatening outcomes with rapid spread of the carbapenemase gene in solid organ transplantation (SOT) recipients because of limitations of available antibiotics. We examined the characteristics and importance of CPE acquisition in SOT recipients with large numbers of CPE isolates. Methods: Between November 2015 and October 2016, 584 CPE isolates were found in 37 recipients and verified by carbapenemase gene multiplex polymerase chain reaction (PCR). One hundred recipients with at least 2 negative results in carbapenemase PCR for stool surveillance and no CPE isolates in clinical samples were retrospectively included. Results: Most CPE isolates were Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (546, 93.5{\%}). The most frequent transplantation organ was lung (43.3{\%}), and the most common sample with CPE isolates other than stool was respiratory tract (22.6{\%}). The median time between SOT and first CPE acquisition was 7 days. All-cause mortality was significantly higher in recipients with CPE than in those without CPE (24.3{\%} vs 10.0{\%}; P =.03). In multivariate regression analysis, stool colonization of vancomycin-resistant Enterococci and/or Clostridium difficile during 30 days before SOT (odds ratio [OR], 3.28; 95{\%} CI, 1.24–8.68; P =.02), lung transplantation (OR, 4.50; 95{\%} CI, 1.19–17.03; P =.03), and intensive care unit stay ≥2 weeks (OR, 6.21; 95{\%} CI, 1.72–22.45; P =.005) were associated with acquisition of CPE. Conclusions: Early posttransplantation CPE acquisition may affect the clinical outcome of SOT recipients. Careful screening for CPE during the early posttransplantation period would be meaningful in recipients with risk factors.",
author = "Lee, {K. H.} and Han, {S. H.} and D. Yong and Paik, {H. C.} and JaeGil Lee and Kim, {M. S.} and Joo, {D. J.} and Choi, {J. S.} and Kim, {S. I.} and Kim, {Y. S.} and Park, {M. S.} and Kim, {S. Y.} and Yoon, {Y. N.} and S. Kang and Jeong, {S. J.} and Choi, {J. Y.} and Song, {Y. G.} and Kim, {J. M.}",
year = "2018",
month = "12",
day = "1",
doi = "10.1016/j.transproceed.2018.01.058",
language = "English",
volume = "50",
pages = "3748--3755",
journal = "Transplantation Proceedings",
issn = "0041-1345",
publisher = "Elsevier USA",
number = "10",

}

Lee, KH, Han, SH, Yong, D, Paik, HC, Lee, J, Kim, MS, Joo, DJ, Choi, JS, Kim, SI, Kim, YS, Park, MS, Kim, SY, Yoon, YN, Kang, S, Jeong, SJ, Choi, JY, Song, YG & Kim, JM 2018, 'Acquisition of Carbapenemase-Producing Enterobacteriaceae in Solid Organ Transplantation Recipients', Transplantation Proceedings, vol. 50, no. 10, pp. 3748-3755. https://doi.org/10.1016/j.transproceed.2018.01.058

Acquisition of Carbapenemase-Producing Enterobacteriaceae in Solid Organ Transplantation Recipients. / Lee, K. H.; Han, S. H.; Yong, D.; Paik, H. C.; Lee, JaeGil; Kim, M. S.; Joo, D. J.; Choi, J. S.; Kim, S. I.; Kim, Y. S.; Park, M. S.; Kim, S. Y.; Yoon, Y. N.; Kang, S.; Jeong, S. J.; Choi, J. Y.; Song, Y. G.; Kim, J. M.

In: Transplantation Proceedings, Vol. 50, No. 10, 01.12.2018, p. 3748-3755.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Acquisition of Carbapenemase-Producing Enterobacteriaceae in Solid Organ Transplantation Recipients

AU - Lee, K. H.

AU - Han, S. H.

AU - Yong, D.

AU - Paik, H. C.

AU - Lee, JaeGil

AU - Kim, M. S.

AU - Joo, D. J.

AU - Choi, J. S.

AU - Kim, S. I.

AU - Kim, Y. S.

AU - Park, M. S.

AU - Kim, S. Y.

AU - Yoon, Y. N.

AU - Kang, S.

AU - Jeong, S. J.

AU - Choi, J. Y.

AU - Song, Y. G.

AU - Kim, J. M.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Background: Carbapenemase-producing Enterobacteriaceae (CPE) can lead to life-threatening outcomes with rapid spread of the carbapenemase gene in solid organ transplantation (SOT) recipients because of limitations of available antibiotics. We examined the characteristics and importance of CPE acquisition in SOT recipients with large numbers of CPE isolates. Methods: Between November 2015 and October 2016, 584 CPE isolates were found in 37 recipients and verified by carbapenemase gene multiplex polymerase chain reaction (PCR). One hundred recipients with at least 2 negative results in carbapenemase PCR for stool surveillance and no CPE isolates in clinical samples were retrospectively included. Results: Most CPE isolates were Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (546, 93.5%). The most frequent transplantation organ was lung (43.3%), and the most common sample with CPE isolates other than stool was respiratory tract (22.6%). The median time between SOT and first CPE acquisition was 7 days. All-cause mortality was significantly higher in recipients with CPE than in those without CPE (24.3% vs 10.0%; P =.03). In multivariate regression analysis, stool colonization of vancomycin-resistant Enterococci and/or Clostridium difficile during 30 days before SOT (odds ratio [OR], 3.28; 95% CI, 1.24–8.68; P =.02), lung transplantation (OR, 4.50; 95% CI, 1.19–17.03; P =.03), and intensive care unit stay ≥2 weeks (OR, 6.21; 95% CI, 1.72–22.45; P =.005) were associated with acquisition of CPE. Conclusions: Early posttransplantation CPE acquisition may affect the clinical outcome of SOT recipients. Careful screening for CPE during the early posttransplantation period would be meaningful in recipients with risk factors.

AB - Background: Carbapenemase-producing Enterobacteriaceae (CPE) can lead to life-threatening outcomes with rapid spread of the carbapenemase gene in solid organ transplantation (SOT) recipients because of limitations of available antibiotics. We examined the characteristics and importance of CPE acquisition in SOT recipients with large numbers of CPE isolates. Methods: Between November 2015 and October 2016, 584 CPE isolates were found in 37 recipients and verified by carbapenemase gene multiplex polymerase chain reaction (PCR). One hundred recipients with at least 2 negative results in carbapenemase PCR for stool surveillance and no CPE isolates in clinical samples were retrospectively included. Results: Most CPE isolates were Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (546, 93.5%). The most frequent transplantation organ was lung (43.3%), and the most common sample with CPE isolates other than stool was respiratory tract (22.6%). The median time between SOT and first CPE acquisition was 7 days. All-cause mortality was significantly higher in recipients with CPE than in those without CPE (24.3% vs 10.0%; P =.03). In multivariate regression analysis, stool colonization of vancomycin-resistant Enterococci and/or Clostridium difficile during 30 days before SOT (odds ratio [OR], 3.28; 95% CI, 1.24–8.68; P =.02), lung transplantation (OR, 4.50; 95% CI, 1.19–17.03; P =.03), and intensive care unit stay ≥2 weeks (OR, 6.21; 95% CI, 1.72–22.45; P =.005) were associated with acquisition of CPE. Conclusions: Early posttransplantation CPE acquisition may affect the clinical outcome of SOT recipients. Careful screening for CPE during the early posttransplantation period would be meaningful in recipients with risk factors.

UR - http://www.scopus.com/inward/record.url?scp=85058516209&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85058516209&partnerID=8YFLogxK

U2 - 10.1016/j.transproceed.2018.01.058

DO - 10.1016/j.transproceed.2018.01.058

M3 - Article

VL - 50

SP - 3748

EP - 3755

JO - Transplantation Proceedings

JF - Transplantation Proceedings

SN - 0041-1345

IS - 10

ER -