title: Pretransplant fecal carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae and infection after liver transplant, France.
abstract: Extended-spectrum β-lactamase-producing Enterobacteriaceae isolates (ESBLE) are emerging pathogens that confer resistance to antimicrobial drugs. We conducted a 10-year study in France (January 2001-April 2010) to investigate the incidence of and risk factors for ESBLE infections after liver transplant. Of 710 transplant patients screened preoperatively for ESBLE fecal carriage, 5.5% had ESBLE infection develop within 4 months after surgery; patients with pretransplant ESBLE fecal carriage were more likely to have infection develop than were noncarriers. Typing showed extensive genetic diversity, with a large predominance of CTX-M enzymes. Independent predictors of ESBLE infection were pretransplant fecal carriage, Model for End Stage Liver Disease score >25, and return to surgery. Our results indicate that the influx of preoperatively acquired ESBLE isolates into the hospital outweighs cross-transmission in the epidemiology of ESBLE infections after liver transplant. Transplant candidates should be systematically screened for carriage, and posttransplant infection in carriers should be treated with carbapenems.
authors.affiliation: Hôpital Beaujon, Clichy, France. frederic.bert@bjn.aphp.fr
authors.forename: Frédéric
authors.initials: F
authors.lastname: Bert
authors.forename: Béatrice
authors.initials: B
authors.lastname: Larroque
authors.forename: Catherine
authors.initials: C
authors.lastname: Paugam-Burtz
authors.forename: Federica
authors.initials: F
authors.lastname: Dondero
authors.forename: François
authors.initials: F
authors.lastname: Durand
authors.forename: Estelle
authors.initials: E
authors.lastname: Marcon
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
authors.forename: Richard
authors.initials: R
authors.lastname: Moreau
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Nicolas-Chanoine
mesh_terms: D000328:Adult; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D004755:Enterobacteriaceae / Q000201:enzymology / Q000235:genetics; D004926:Escherichia coli / Q000201:enzymology / Q000235:genetics*; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D059413:Intraabdominal Infections / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D008107:Liver Diseases / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D058889:Molecular Typing; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism
chemical_list: C055184:beta-lactamase TEM-3; D001618:beta-Lactamases