title: Factors influencing mortality in abdominal solid organ transplant recipients with multidrug-resistant gram-negative bacteremia.
abstract: Although multidrug-resistant (MDR) gram-negative bacteremia (GNB) has been recognized as an important cause of morbidity and mortality among abdominal solid organ transplant (ASOT) recipients, there are no data on its prognostic factors after an interim standard definition of MDR was proposed in 2012. The objective of this study was to describe the epidemiology, microbiology, and predictors of infection-related 30-day mortality in ASOT recipients with MDR GNB.
  
  
  
  We performed a retrospective, double-center analysis of ASOT patients with MDR GNB over a 13-year study period. Univariate and multivariate analyses were performed to identify the risk factors for mortality.
  
  
  
  During the observational period, 2169 subjects underwent ASOT. Ninety-nine episodes of MDR GNB were diagnosed in 91 (4.6%) ASOT recipients, with a predominance of E.coli (29 isolates, 29.3%) and A.baumanii (24 isolates, 24.2%). The median age of these 91 recipients was 45 years (interquartile range 35-54). Mortality after the first episode of MDR GNB was 39.6% (36 deaths). The univariate analysis identified the following variables as predictors of MDR GNB-related mortality: lung focus (P = 0.001),nosocomial origin (P = 0.002), graft from donation after cardiac death or deceased donors (P = 0.023), presence of other concomitant bloodstream infection (P < 0.001), temperature of 40 °C or greater at the onset of MDR GNB (P = 0.039), creatinine > 1.5 mg/dl (P = 0.006), albumin < 30 g/L (P = 0.009), platelet count < 50,000/mm3(P < 0.001), and septic shock (P < 0.001). In the multivariate logistic regression analysis, septic shock (odds ratio (OR) = 160.463, 95% confidence interval (CI) = 19.377-1328.832, P < .001), as well as creatinine > 1.5 mg/dl (OR = 24.498, 95% CI = 3.449-173.998, P = 0.001), nosocomial origin (OR = 23.963, 95% CI = 1.285-46.991, P = 0.033), and presence of other concomitant bloodstream infections (OR = 27.074, 95% CI = 3.937-186.210, P = 0.001) were the variables associated with MDR GNB-related 30-day mortality.
  
  
  
  MDR GNB was associated with high morbidity and mortality in ASOT recipients, with a predominant causative organisms being E.coli and A.baumanii. Nosocomial origin, as well as presence of other concomitant bloodstream infections, increased creatinine level and septic shock were the main predictors of MDR GNB-related 30-day mortality.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, People's Republic of China.
authors.forename: Bingbing
authors.initials: B
authors.lastname: Qiao
authors.affiliation: Department of Cadre Care, the Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, People's Republic of China.
authors.forename: Jianzhen
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Transplant Surgery, the Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, People's Republic of China. 13548685542@163.com.
authors.forename: Qiquan
authors.initials: Q
authors.lastname: Wan
authors.affiliation: Department of Transplant Surgery, the Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, People's Republic of China.
authors.forename: Sheng
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Department of Transplant Surgery, the Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, People's Republic of China.|Department of Transplant Surgery, Zhongnan Hospital, Wuhan University, Wuhan 430071, Hubei, People's Republic of China.
authors.forename: Qifa
authors.initials: Q
authors.lastname: Ye
mesh_terms: D000005:Abdomen; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology / Q000401:mortality*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005500:Follow-Up Studies; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology / Q000401:mortality*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016377:Organ Transplantation; D011183:Postoperative Complications / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Abdominal solid organ transplantation; Gram-negative bacteremia; Mortality; Multidrug-resistant; Predictors