ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2022
Molecular Epidemiology, Natural History, and Long-Term Outcomes of Multidrug-Resistant Enterobacterales Colonization and Infections Among Solid Organ Transplant Recipients.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 42 citations in OpenAlex.
- A comprehensive evaluation of risk factors for mortality, infection and colonization associated with CRGNB in adult solid organ transplant recipients: a systematic review and meta-analysis.Annals of medicine · 2024Pooled it
- Emergence ofbioRxiv : the preprint server for biology · 2025Article
- Can We Lower the Burden of Antimicrobial Resistance (AMR) in Heavily Immunocompromised Patients? A Narrative Review and Call to Action.Infectious diseases and therapy · 2025Review
- Ceftazidime-Avibactam in Critically Ill Patients: A Multicenter Observational Study.Antibiotics (Basel, Switzerland) · 2025Article
- Evaluation of Perioperative Risk Factors for Infection by Multidrug-Resistant Bacteria in Patients Undergoing Liver Transplantation.Journal of personalized medicine · 2025Article
- Carbapenem-resistant Enterobacterales in solid organ transplant recipients.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2025Article
- Emergence of high-level aztreonam-avibactam and cefiderocol resistance following treatment of an NDM-producingJAC-antimicrobial resistance · 2024Article
- Risk Factors for Infectious Complications following Endoscopic Retrograde Cholangiopancreatography in Liver Transplant Patients: A Single-Center Study.Journal of clinical medicine · 2024Article
- Burden and Management of Multi-Drug Resistant Organism Infections in Solid Organ Transplant Recipients Across the World: A Narrative Review.Transplant international : official journal of the European Society for Organ Transplantation · 2024Review
- Antibiotic stewardship implementation at the largest solid organ transplantation center in Asia: a retrospective cohort study.BMC surgery · 2023Article
- Cefiderocol, a Siderophore Cephalosporin, as a Treatment Option for Infections Caused by Carbapenem-Resistant Enterobacterales.Infectious diseases and therapy · 2023Review
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- Article
- Genomic dissection of Klebsiella pneumoniae infections in hospital patients reveals insights into an opportunistic pathogen.Nature communications · 2022Article
- International Survey on Antibiotic Prophylaxis Approaches for Solid Organ Transplant Recipients and Donors Colonized With Multidrug-Resistant Organisms.Transplant infectious disease : an official journal of the Transplantation SocietyArticle
- Outcomes of Living Donor Liver Transplantation in Recipients Colonized With Carbapenem-Resistant Enterobacterales.Journal of clinical and experimental hepatologyArticle
Corrections and comments
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Authors and funding
10 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundMultidrug-resistant Enterobacterales (MDR-E), including carbapenem-resistant and third-generation cephalosporin-resistant Enterobacterales (CRE, CefR-E), are major pathogens following solid organ transplantation (SOT).
methodsWe prospectively studied patients who underwent lung, liver, and small bowel transplant from February 2015 through March 2017. Weekly perirectal swabs (up to 100 days post-transplant) were cultured for MDR-E. Whole-genome sequencing (WGS) was performed on gastrointestinal (GI) tract-colonizing and disease-causing isolates.
resultsTwenty-five percent (40 of 162) of patients were MDR-E GI-colonized. Klebsiella pneumoniae was the most common CRE and CefR-E. Klebsiella pneumoniae carbapenemases and CTX-M were leading causes of CR and CefR, respectively. Thirty-five percent of GI colonizers developed MDR-E infection vs 2% of noncolonizers (P < .0001). The attack rate was higher among CRE colonizers than CefR-E colonizers (53% vs 21%, P = .049). GI colonization and high body mass index were independent risk factors for MDR-E infection (P ≤ .004). Thirty-day mortality among infected patients was 6%. However, 44% of survivors developed recurrent infections; 43% of recurrences were late (285 days to 3.9 years after the initial infection). Long-term survival (median, 4.3 years post-transplant) did not differ significantly between MDR-E-infected and MDR-E-noninfected patients (71% vs 77%, P = .56). WGS phylogenetic analyses revealed that infections were caused by GI-colonizing strains and suggested unrecognized transmission of novel clonal group-258 sublineage CR-K. pneumoniae and horizontal transfer of resistance genes.
conclusionsMDR-E GI colonization was common following SOT and predisposed patients to infections by colonizing strains. MDR-E infections were associated with low short- and long-term mortality, but recurrences were frequent and often occurred years after initial infections. Findings provide support for MDR-E surveillance in our SOT program.
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