title: Carbapenem-Resistant Enterobacteriaceae Acquired Before Liver Transplantation: Impact on Recipient Outcomes.
abstract: Carbapenem-resistant Enterobacteriaceae (CRE) is an emergent microorganism of infections after liver transplant (LT). The aim of this study was to analyze the risk factors for CRE acquisition and infection after LT.
  
  
  
  This was a prospective cohort study involving patients who underwent LT in the 2010 to 2014 period. Surveillance cultures for CRE were collected immediately before LT and weekly thereafter until hospital discharge.
  
  
  
  We analyzed 386 patients undergoing a total of 407 LTs. Before LT, 68 (17.6%) patients tested positive for CRE, 11 (16.2%) of those patients having CRE infection, whereas 119 (30.8%) patients acquired CRE after LT. Post-LT CRE infection was identified in 59 (15.7%) patients: Klebsiella pneumoniae was isolated in 83.2%; surgical site infection was the most common type of infection (46.7%). Multivariate analysis showed that post-LT dialysis was the only risk factor for post-LT CRE acquisition. Eighty-two percent of patients who underwent 3 or more post-LT dialysis sessions and acquired CRE before LT evolved with post-LT CRE infection. Other risk factors for CRE infection were acquisition of CRE post-LT, Model for End-Stage Liver Disease score greater than 32, combined transplantation, and reoperation. Patients who acquired CRE before LT had a high risk of developing CRE infection (P < 0.001).
  
  
  
  Measures for minimizing that risk, including altering the antibiotic prophylaxis, should be investigated and implemented.
authors.affiliation: 1 Infection Control Team, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil. 2 Department of Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil. 3 Liver and Intestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil. 4 Microbiology Research Laboratory-LIM54, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil. 5 Centro de Bacteriologia, Instituto Adolfo Lutz, São Paulo, Brazil. 6 Microbiology Laboratory, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil.
authors.forename: Maristela Pinheiro
authors.initials: MP
authors.lastname: Freire
authors.forename: Isabel C V S
authors.initials: IC
authors.lastname: Oshiro
authors.forename: Ligia C
authors.initials: LC
authors.lastname: Pierrotti
authors.forename: Patricia R
authors.initials: PR
authors.lastname: Bonazzi
authors.forename: Larissa M
authors.initials: LM
authors.lastname: de Oliveira
authors.forename: Alice T W
authors.initials: AT
authors.lastname: Song
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Camargo
authors.forename: Inneke M
authors.initials: IM
authors.lastname: van der Heijden
authors.forename: Flavia
authors.initials: F
authors.lastname: Rossi
authors.forename: Silvia F
authors.initials: SF
authors.lastname: Costa
authors.forename: Luiz A C
authors.initials: LA
authors.lastname: DʼAlbuquerque
authors.forename: Edson
authors.initials: E
authors.lastname: Abdala
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015780:Carbapenems / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D024881:Drug Resistance, Bacterial; D004756:Enterobacteriaceae Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects; D018570:Risk Assessment; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D013997:Time Factors; D066027:Transplant Recipients; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015780:Carbapenems