title: Surveillance culture for multidrug-resistant gram-negative bacteria: Performance in liver transplant recipients.
abstract: BACKGROUND
  The prevalence of infection with multidrug-resistant gram-negative bacteria (MDR-GNB) after solid-organ transplantation is increasing. Surveillance culture (SC) seems to be an important tool for MDR-GNB control. The goal of this study was to analyze the performance of SC for MDR-GNB among liver transplant (LT) recipients.
  
  
  METHODS
  This was a prospective cohort study involving patients who underwent LT between November 2009 and November 2011. We screened patients for extended spectrum β-lactamase-producing Escherichia coli, extended spectrum β-lactamase-producing Klebsiella pneumoniae, and carbapenem-resistant Enterobacteriaceae, carbapenem-resistant Pseudomonas aeruginosa (CRPA), and carbapenem-resistant Acinetobacter baumannii (CRAB). We collected SC samples immediately before LT and weekly thereafter, until hospital discharge. Samples were collected from the inguinal-rectal area, axilla, and throat. The performance of SC was evaluated through analysis of its sensitivity, negative predictive value, and accuracy.
  
  
  RESULTS
  During the study period, 181 patients were evaluated and 4,110 SC samples were collected. The GNB most often identified was CRAB, in 45.9% of patients, followed by CRKP in 40.3%. For all microorganisms, the positivity rate was highest among the inguinal-rectal samples. If only samples collected from this area were considered, the SC would fail to identify 34.9% of the cases of CRAB colonization. The sensitivity of SC for CRKP was 92.5%. The performance of SC was poorest for CRAB (sensitivity, 80.6%).
  
  
  CONCLUSIONS
  Our data indicate that SC is a sensitive tool to identify LT recipients colonized by MDR-GNB.
authors.affiliation: Infection Control Team, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil. Electronic address: maristelapf@uol.com.br.
authors.forename: Maristela Pinheiro
authors.initials: MP
authors.lastname: Freire
authors.affiliation: Infection Control Team, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil.
authors.forename: Isabel Cristina
authors.initials: IC
authors.lastname: Villela Soares Oshiro
authors.affiliation: Liver and Intestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Patrícia Rodrigues
authors.initials: PR
authors.lastname: Bonazzi
authors.affiliation: Department of Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Ligia Câmera
authors.initials: LC
authors.lastname: Pierrotti
authors.affiliation: Microbiology Research Laboratory-LIM54, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil.
authors.forename: Larissa Marques
authors.initials: LM
authors.lastname: de Oliveira
authors.affiliation: Infection Control Team, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil.
authors.forename: Anna Silva
authors.initials: AS
authors.lastname: Machado
authors.affiliation: Microbiology Research Laboratory-LIM54, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil.
authors.forename: Inneke Marie
authors.initials: IM
authors.lastname: Van Der Heijdenn
authors.affiliation: Microbiology Laboratory, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil.
authors.forename: Flavia
authors.initials: F
authors.lastname: Rossi
authors.affiliation: Department of Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil; Microbiology Research Laboratory-LIM54, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil.
authors.forename: Silvia Figueiredo
authors.initials: SF
authors.lastname: Costa
authors.affiliation: Liver and Intestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Luiz Augusto
authors.initials: LA
authors.lastname: Carneiro D'Albuquerque
authors.affiliation: Liver and Intestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil; Department of Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Edson
authors.initials: E
authors.lastname: Abdala
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001431:Bacteriological Techniques; D024901:Drug Resistance, Multiple, Bacterial; D062665:Epidemiological Monitoring; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D066027:Transplant Recipients; D055815:Young Adult
keywords: Acinetobacter baumannii; Extended spectrum β-lactamase; Infection; Klebsiella pneumoniae; Pseudomonas aeruginosa; Risk factor for infection