title: Carbapenem-resistant Acinetobacter baumannii acquired before liver transplantation: Impact on recipient outcomes.
abstract: Infection with carbapenem-resistant Acinetobacter baumannii (CRAB) after liver transplantation (LT) is associated with high mortality. This study aimed to identify risk factors for post-LT CRAB infection, as well as to evaluate the impact of pre-LT CRAB acquisition on the incidence of post-LT CRAB infection. This was a prospective cohort study of all patients undergoing LT at our facility between October 2009 and October 2011. Surveillance cultures (SCs) were collected immediately before LT and weekly thereafter, until discharge. We analyzed 196 patients who were submitted to 222 LTs. CRAB was identified in 105 (53.6%); 24 (22.9%) of these patients were found to have acquired CRAB before LT, and 85 (81.0%) tested positive on SCs. Post-LT CRAB infection occurred in 56 (28.6%), the most common site being the surgical wound. Multivariate analysis showed that the risk factors for developing CRAB infection were prolonged cold ischemia, post-LT dialysis, LT due to fulminant hepatitis, and pre-LT CRAB acquisition with pre-LT CRAB acquisition showing a considerable trend toward significance (P = 0.06). Among the recipients with CRAB infection, 60-day mortality was 46.4%, significantly higher than among those without (P < 0.001). Mortality risk factors were post-LT infection with multidrug-resistant bacteria, LT performed because of fulminant hepatitis, retransplantation, prolonged cold ischemia, longer LT surgical time, and pre-LT CRAB acquisition, the last showing a trend toward significance (P = 0.08). In conclusion, pre-LT CRAB acquisition appears to increase the risk of post-LT CRAB infection, which has a negative impact on recipient survival. Liver Transplantation 22 615-626 2016 AASLD.
authors.affiliation: Infection Control Team, University of São Paulo, São Paulo, Brazil.
authors.forename: Maristela Pinheiro
authors.initials: MP
authors.lastname: Freire
authors.affiliation: Department of Infectious Diseases; and, University of São Paulo, São Paulo, Brazil.
authors.forename: Ligia Câmera
authors.initials: LC
authors.lastname: Pierrotti
authors.affiliation: Infection Control Team, University of São Paulo, São Paulo, Brazil.
authors.forename: Isabel Cristina Villela Soares
authors.initials: IC
authors.lastname: Oshiro
authors.affiliation: Liver and Intestinal Transplant Division, Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Patrícia Rodrigues
authors.initials: PR
authors.lastname: Bonazzi
authors.affiliation: Microbiology Research Laboratory, University of São Paulo, São Paulo, Brazil.
authors.forename: Larissa Marques de
authors.initials: LM
authors.lastname: Oliveira
authors.affiliation: Infection Control Team, University of São Paulo, São Paulo, Brazil.
authors.forename: Anna Silva
authors.initials: AS
authors.lastname: Machado
authors.affiliation: Microbiology Research Laboratory, University of São Paulo, São Paulo, Brazil.
authors.forename: Inneke Marie
authors.initials: IM
authors.lastname: Van Der Heijden
authors.affiliation: Microbiology Laboratory, Hospital das Clínicas, and, University of São Paulo, São Paulo, Brazil.
authors.forename: Flavia
authors.initials: F
authors.lastname: Rossi
authors.affiliation: Microbiology Research Laboratory, University of São Paulo, São Paulo, Brazil.|Department of Infectious Diseases; and, University of São Paulo, São Paulo, Brazil.
authors.forename: Silvia Figueiredo
authors.initials: SF
authors.lastname: Costa
authors.affiliation: Liver and Intestinal Transplant Division, Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Luiz Augusto Carneiro
authors.initials: LA
authors.lastname: D'Albuquerque
authors.affiliation: Department of Infectious Diseases; and, University of São Paulo, São Paulo, Brazil.|Liver and Intestinal Transplant Division, Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Edson
authors.initials: E
authors.lastname: Abdala
mesh_terms: D000151:Acinetobacter Infections / Q000150:complications* / Q000188:drug therapy; D040981:Acinetobacter baumannii / Q000187:drug effects; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015780:Carbapenems / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000150:complications* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems