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Impact of deceased donor multidrug-resistant bacterial organisms on organ utilization.
American Journal of Transplantation ( IF 8.8 ) Pub Date : 2020-02-23 , DOI: 10.1111/ajt.15830 Judith A Anesi 1, 2 , Jennifer H Han 3 , Ebbing Lautenbach 1, 2, 4 , Dong H Lee 5 , Heather Clauss 6 , Antonette Climaco 7 , Warren B Bilker 2, 4 , Richard Hasz 8 , Esther Molnar 6 , Darcy Alimenti 1, 2 , Sharon West 8 , Pam Tolomeo 2, 4 , Emily A Blumberg 1 ,
American Journal of Transplantation ( IF 8.8 ) Pub Date : 2020-02-23 , DOI: 10.1111/ajt.15830 Judith A Anesi 1, 2 , Jennifer H Han 3 , Ebbing Lautenbach 1, 2, 4 , Dong H Lee 5 , Heather Clauss 6 , Antonette Climaco 7 , Warren B Bilker 2, 4 , Richard Hasz 8 , Esther Molnar 6 , Darcy Alimenti 1, 2 , Sharon West 8 , Pam Tolomeo 2, 4 , Emily A Blumberg 1 ,
Affiliation
The extent to which donor multidrug‐resistant organisms (MDROs) affect organ utilization remains unclear. We performed a retrospective cohort study at 4 transplant centers between 2015 and 2016 to evaluate this question. All deceased donors who donated at least one organ were included. Exposed donors had at least one MDRO on culture. Unexposed donors had no MDRO‐positive cultures. Only cultures obtained during the donor's terminal hospitalization were evaluated. Multivariable regression was used to determine the association between donor MDRO and (1) number of organs transplanted per donor and (2) the match run at which each organ was accepted. Subsequently, we restricted the analysis to donors with MDR‐Gram‐negative (GN) organisms. Of 440 total donors, 29 (7%) donors grew MDROs and 7 (2%) grew MDR‐GNs. There was no significant association between donor MDRO and either measure of organ utilization. However, donor MDR‐GNs were associated with a significant reduction in the number of organs transplanted per donor (incidence rate ratio 0.43, 95% confidence interval [CI] 0.39‐0.48, P < .01), and organs were accepted significantly further down the match list (relative count 5.08, 95% CI 1.64‐15.68, P = .01). Though donor MDR‐GNs were infrequent in our study, their growing prevalence could meaningfully reduce the donor pool over time.
中文翻译:
已故供体多重耐药细菌对器官利用的影响。
供体多重耐药菌 (MDRO) 影响器官利用的程度仍不清楚。我们在 2015 年至 2016 年期间在 4 个移植中心进行了一项回顾性队列研究来评估这个问题。所有捐献至少一个器官的已故捐献者都包括在内。暴露的捐赠者至少有一个关于培养的 MDRO。未暴露的捐赠者没有 MDRO 阳性培养物。仅对捐赠者临终住院期间获得的培养物进行了评估。多变量回归用于确定供体 MDRO 与 (1) 每个供体移植的器官数量和 (2) 每个器官被接受的匹配运行之间的关联。随后,我们将分析限制在具有耐多药革兰氏阴性 (GN) 生物体的供体。在 440 名总捐助者中,29 名 (7%) 捐助者长出了 MDRO,7 名 (2%) 长出了 MDR-GN。供体 MDRO 与任一器官利用指标之间均无显着关联。然而,供体 MDR-GNs 与每个供体移植器官数量的显着减少相关(发生率比 0.43,95% 置信区间 [CI] 0.39-0.48,P < .01),器官在匹配列表中被接受的位置明显靠后(相对计数 5.08,95% CI 1.64-15.68,P = .01)。尽管供体 MDR-GN 在我们的研究中并不常见,但随着时间的推移,它们日益流行可能会显着减少供体库。
更新日期:2020-02-23
中文翻译:
已故供体多重耐药细菌对器官利用的影响。
供体多重耐药菌 (MDRO) 影响器官利用的程度仍不清楚。我们在 2015 年至 2016 年期间在 4 个移植中心进行了一项回顾性队列研究来评估这个问题。所有捐献至少一个器官的已故捐献者都包括在内。暴露的捐赠者至少有一个关于培养的 MDRO。未暴露的捐赠者没有 MDRO 阳性培养物。仅对捐赠者临终住院期间获得的培养物进行了评估。多变量回归用于确定供体 MDRO 与 (1) 每个供体移植的器官数量和 (2) 每个器官被接受的匹配运行之间的关联。随后,我们将分析限制在具有耐多药革兰氏阴性 (GN) 生物体的供体。在 440 名总捐助者中,29 名 (7%) 捐助者长出了 MDRO,7 名 (2%) 长出了 MDR-GN。供体 MDRO 与任一器官利用指标之间均无显着关联。然而,供体 MDR-GNs 与每个供体移植器官数量的显着减少相关(发生率比 0.43,95% 置信区间 [CI] 0.39-0.48,P < .01),器官在匹配列表中被接受的位置明显靠后(相对计数 5.08,95% CI 1.64-15.68,P = .01)。尽管供体 MDR-GN 在我们的研究中并不常见,但随着时间的推移,它们日益流行可能会显着减少供体库。