title: [Clinical impact of infections with carbapenem-resistant enterobacteriaceae in liver transplant recipients].
abstract: Infections with carbapenem-resistant Enterobacteriaceae (CRE) are an emerging cause of morbidity and mortality among liver transplant recipients (LTR) worldwide, particularly Klebsiella pneumoniae carbapenemase (KPC)-producing organisms. Approximately 3 - 13 % of solid organ transplant recipients in CRE-endemic areas develop CRE infections, and the infection site correlates with the transplanted organ. The cumulative 30-day mortality rate of LTR infected with carbapenem-resistant K. pneumoniae is 36 %, and the 180-day mortality rate is 58 %. Awareness of the high vulnerability of LTR to fatal bacterial infection leads to the more frequent use of ultrabroad-spectrum empirical antibiotic therapy, which further contributes to the selection of extreme drug resistance. Moreover, it comprises a relevant risk of failure to initiate adequate empirical treatment due to the fact that culture-based techniques used to identify CRE imply a 48- to 72-hour delay from blood culture collection until administration of the targeted therapy. This vicious circle is difficult to avoid and leads to increased clinical intricacy and narrowed antimicrobial therapeutic options. Because available options are extremely limited, infection prevention measures have gained outstanding importance, particularly in the phase after liver transplant requiring intense immunosuppression early on. Improving clinical outcomes is a major challenge and involves a multi-targeted approach combining strictly applied hygiene measures, active surveillance tests, the use of modern, time-saving methods of molecular biology, and enforced antibiotic stewardship. This article reviews the current literature regarding the incidence and outcome of CRE infections in LTR, and it summarises current preventive and therapeutic recommendations to minimise the threat by CRE in real-life clinical transplant settings.
authors.affiliation: Fachbereich Infektions- und Tropenmedizin, Klinik für Gastroenterologie und Rheumatologie, Universitätsklinikum Leipzig.
authors.forename: C
authors.initials: C
authors.lastname: Lübbert
authors.affiliation: Klinik für Viszeral-, Gefäß-, Thorax- und Transplantationschirurgie, Universitätsklinikum Leipzig.
authors.forename: H M
authors.initials: HM
authors.lastname: Hau
authors.affiliation: Institut für Medizinische Mikrobiologie und Infektionsepidemiologie, Universitätsklinikum Leipzig.
authors.forename: A
authors.initials: A
authors.lastname: Rodloff
authors.affiliation: Klinik für Gastroenterologie und Rheumatologie, Universitätsklinikum Leipzig.
authors.forename: J
authors.initials: J
authors.lastname: Mössner
authors.affiliation: Abteilung Infektiologie, Klinik für Innere Medizin II, Universitätsklinikum Freiburg.
authors.forename: A
authors.initials: A
authors.lastname: Mischnik
authors.affiliation: Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Leipzig.
authors.forename: S
authors.initials: S
authors.lastname: Bercker
authors.forename: M
authors.initials: M
authors.lastname: Bartels
authors.forename: U X
authors.initials: UX
authors.lastname: Kaisers
mesh_terms: D015780:Carbapenems / Q000627:therapeutic use*; D015984:Causality; D015897:Comorbidity; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000382:microbiology / Q000401:mortality* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D011183:Postoperative Complications / Q000382:microbiology / Q000401:mortality* / Q000517:prevention & control; D018570:Risk Assessment; D066027:Transplant Recipients / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D015780:Carbapenems