title: Risk factors and outcomes of bacteremia caused by drug-resistant ESKAPE pathogens in solid-organ transplant recipients.
abstract: BACKGROUND
  Although infections due to the six ESKAPE pathogens have recently been identified as a serious emerging problem, information regarding bacteremia caused by these organisms in solid-organ transplant (SOT) recipients is lacking. We sought to determine the frequency, risk factors, and outcomes of bacteremia due to drug-resistant ESKAPE (rESKAPE) organisms in liver, kidney, and heart adult transplant recipients.
  
  
  METHODS
  All episodes of bacteremia prospectively documented in hospitalized SOT recipients from 2007 to 2012 were analyzed.
  
  
  RESULTS
  Of 276 episodes of bacteremia, 54 (19.6%) were due to rESKAPE strains (vancomycin-resistant Enterococcus faecium [0], methicillin-resistant Staphylococcus aureus [5], extended-spectrum β-lactamase-producing Klebsiella pneumoniae [10], carbapenem-resistant Acinetobacter baumannii [8], carbapenem- and quinolone-resistant Pseudomonas aeruginosa [26], and derepressed chromosomal β-lactam and extended-spectrum β-lactamase-producing Enterobacter species [5]). Factors independently associated with rESKAPE bacteremia were prior transplantation, septic shock, and prior antibiotic therapy. Patients with rESKAPE bacteremia more often received inappropriate empirical antibiotic therapy than the others (41% vs. 21.6%; P=0.01). Overall case-fatality rate (30 days) was higher in patients with rESKAPE bacteremia (35.2% vs. 14.4%; P=0.001).
  
  
  CONCLUSIONS
  Bacteremia due to rESKAPE pathogens is frequent in SOT recipients and causes significant morbidity and mortality. rESKAPE organisms should be considered when selecting empirical antibiotic therapy for hospitalized SOT recipients presenting with septic shock, particularly those with prior transplantation and antibiotic use.
authors.affiliation: 1 Infectious Disease Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. 2 Microbiology Department, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Insituto de Salud Carlos III, Madrid, Spain. 3 General Surgery Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. 4 Gastroenterology Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. 5 Cardiology Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. 6 Nefrology Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. 7 Address correspondence to: Marta Bodro, Infectious Disease Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Bodro
authors.forename: Núria
authors.initials: N
authors.lastname: Sabé
authors.forename: Fe
authors.initials: F
authors.lastname: Tubau
authors.forename: Laura
authors.initials: L
authors.lastname: Lladó
authors.forename: Carme
authors.initials: C
authors.lastname: Baliellas
authors.forename: Josep
authors.initials: J
authors.lastname: Roca
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Cruzado
authors.forename: Jordi
authors.initials: J
authors.lastname: Carratalà
mesh_terms: D040981:Acinetobacter baumannii / Q000472:pathogenicity; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D001419:Bacteria / Q000187:drug effects / Q000472:pathogenicity*; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D016009:Chi-Square Distribution; D024881:Drug Resistance, Bacterial; D004754:Enterobacter / Q000472:pathogenicity; D016984:Enterococcus faecium / Q000472:pathogenicity; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects; D007711:Klebsiella pneumoniae / Q000472:pathogenicity; D016031:Liver Transplantation / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000472:pathogenicity; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016377:Organ Transplantation / Q000009:adverse effects* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D011550:Pseudomonas aeruginosa / Q000472:pathogenicity; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents