title: Incidence of carbapenem-resistant gram negatives in Italian transplant recipients: a nationwide surveillance study.
abstract: BACKGROUND
  Bacterial infections remain a challenge to solid organ transplantation. Due to the alarming spread of carbapenem-resistant gram negative bacteria, these organisms have been frequently recognized as cause of severe infections in solid organ transplant recipients.
  
  
  RESULTS
  Between 15 May and 30 September 2012 we enrolled 887 solid organ transplant recipients in Italy with the aim to describe the epidemiology of gram negative bacteria spreading, to explore potential risk factors and to assess the effect of early isolation of gram negative bacteria on recipients' mortality during the first 90 days after transplantation. During the study period 185 clinical isolates of gram negative bacteria were reported, for an incidence of 2.39 per 1000 recipient-days. Positive cultures for gram negative bacteria occurred early after transplantation (median time 26 days; incidence rate 4.33, 1.67 and 1.14 per 1,000 recipient-days in the first, second and third month after SOT, respectively). Forty-nine of these clinical isolates were due to carbapenem-resistant gram negative bacteria (26.5%; incidence 0.63 per 1000 recipient-days). Carbapenems resistance was particularly frequent among Klebsiella spp. isolates (49.1%). Recipients with longer hospital stay and those who received either heart or lung graft were at the highest risk of testing positive for any gram negative bacteria. Moreover recipients with longer hospital stay, lung recipients and those admitted to hospital for more than 48h before transplantation had the highest probability to have culture(s) positive for carbapenem-resistant gram negative bacteria. Forty-four organ recipients died (0.57 per 1000 recipient-days) during the study period. Recipients with at least one positive culture for carbapenem-resistant gram negative bacteria had a 10.23-fold higher mortality rate than those who did not.
  
  
  CONCLUSIONS
  The isolation of gram-negative bacteria is most frequent among recipient with hospital stays >48 hours prior to transplant and in those receiving either heart or lung transplants. Carbapenem-resistant gram negative isolates are associated with significant mortality.
authors.affiliation: Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Lanini
authors.affiliation: Italian National Transplant Center, Italian National Institute of Health (ISS), Rome, Italy.
authors.forename: Alessandro Nanni
authors.initials: AN
authors.lastname: Costa
authors.affiliation: Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Puro
authors.affiliation: Italian National Transplant Center, Italian National Institute of Health (ISS), Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Procaccio
authors.affiliation: Division of Infectious Diseases, Department of Surgical and Morphological Sciences, University of Insubria-Ospedale di Circolo, Varese, Italy.
authors.forename: Paolo Antonio
authors.initials: PA
authors.lastname: Grossi
authors.affiliation: Italian National Transplant Center, Italian National Institute of Health (ISS), Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Vespasiano
authors.affiliation: Italian National Transplant Center, Italian National Institute of Health (ISS), Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ricci
authors.affiliation: Direzione Generale Salute Lombardia, Regione Lombardia, Milan, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Vesconi
authors.affiliation: Divisions of Infectious Diseases & Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Ison
authors.affiliation: Division of Epidemiology and the Laboratory for Molecular Epidemiology and Antibiotic Research, Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Carmeli
authors.affiliation: Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ippolito
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D015780:Carbapenems / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D012307:Risk Factors; D066027:Transplant Recipients; D018440:beta-Lactam Resistance / Q000502:physiology*
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems
references.citation: Infect Control Hosp Epidemiol. 2009 Jul;30(7):659-65
references.pmid: 19496645
references.citation: Transpl Infect Dis. 2012 Jun;14(3):229-36
references.pmid: 22624726
references.citation: J Heart Lung Transplant. 2010 Aug;29(8):914-56
references.pmid: 20643330
references.citation: Liver Transpl. 2012 Apr;18(4):468-74
references.pmid: 22467548
references.citation: Clin Infect Dis. 2001 Jul 1;33 Suppl 1:S58-65
references.pmid: 11389524
references.citation: Respirology. 2013 Jan;18(1):22-38
references.pmid: 22591266
references.citation: Transpl Infect Dis. 2012 Apr;14(2):198-205
references.pmid: 22093103
references.citation: N Engl J Med. 2007 Dec 20;357(25):2601-14
references.pmid: 18094380
references.citation: Clin Transplant. 2012 Jul-Aug;26(4):E388-94
references.pmid: 22882693
references.citation: Am J Transplant. 2009 Dec;9 Suppl 4:S3-6
references.pmid: 20070692
references.citation: Euro Surveill. 2013 May 30;18(22):
references.pmid: 23787077
references.citation: Ann Ist Super Sanita. 2007;43(3):279-86
references.pmid: 17938459
references.citation: Infect Control Hosp Epidemiol. 2013 Aug;34(8):809-17
references.pmid: 23838221
references.citation: Ann Thorac Surg. 2013 Aug;96(2):596-601
references.pmid: 23773731
references.citation: Transplantation. 2013 Mar 27;95(6):878-82
references.pmid: 23511213
references.citation: Am J Respir Crit Care Med. 2001 Jan;163(1):43-8
references.pmid: 11208624