Objective

To investigate the impact of colonization with carbapenemase-producing Enterobacteriaceae (CPE) on the CPE infection risk after liver transplantation (LT).

Methods

Prospective cohort study of all adult patients undergoing LT at our centre over an 8-year period (2010–2017). Individuals were screened for CPE colonization by rectal swabs at inclusion onto the waiting list, immediately before LT and weekly after LT until hospital discharge. Asymptomatic carriers did not receive decolonization, anti-CPE prophylaxis or pre-emptive antibiotic therapy. Participants were followed up for 1 year after LT.

Results

We analysed 553 individuals who underwent a first LT, 38 were colonized with CPE at LT and 104 acquired colonization after LT. CPE colonization rates at LT and acquired after LT increased significantly over the study period: incidence rate ratios (IRR) 1.21 (95% CI 1.05–1.39) and 1.17 (95% CI 1.07–1.27), respectively. Overall, 57 patients developed CPE infection within a median of 31 (interquartile range 11–115) days after LT, with an incidence of 3.05 cases per 10 000 LT-recipient-days and a non-significant increase over the study period (IRR 1.11, 95% CI 0.98–1.26). In multivariable analysis, CPE colonization at LT (hazard ratio (HR) 18.50, 95% CI 6.76–50.54) and CPE colonization acquired after LT (HR 16.89, 95% CI 6.95–41.00) were the strongest risk factors for CPE infection, along with combined transplant (HR 2.60, 95% CI 1.20–5.59), higher Model for End-Stage Liver Disease at the time of LT (HR 1.03, 95% CI 1.00–1.07), prolonged mechanical ventilation (HR 2.63, 95% CI 1.48–4.67), re-intervention (HR 2.16, 95% CI 1.21–3.84) and rejection (HR 2.81, 95% CI 1.52–5.21).

Conclusions

CPE colonization at LT or acquired after LT were the strongest predictors of CPE infection. Prevention strategies focused on LT candidates and recipients colonized with CPE should be investigated.

中文翻译：

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产生碳青霉烯酶的肠杆菌科细菌定植对肝移植后感染风险的影响：一项前瞻性观察队列研究

客观的

调查产生碳青霉烯酶的肠杆菌科细菌（CPE）的定殖对肝移植（LT）后CPE感染风险的影响。

方法

在我们中心进行为期8年（2010-2017年）的所有接受LT治疗的成年患者的前瞻性队列研究。在入院前，入院前和入院后每周一次，通过直肠拭子筛选个体的CPE定植。无症状携带者未接受非殖民化，抗CPE预防或先发性抗生素治疗。LT后对参与者进行了为期一年的随访。

结果

我们分析了553例接受首次LT的个体，其中38例在LT感染了CPE，在LT感染后获得了104个定植。在研究期间，LT和LT后获得的CPE定植率显着增加：发生率（IRR）分别为1.21（95％CI 1.05-1.39）和1.17（95％CI 1.07-1.27）。总体而言，有57位患者在LT发生后31天内（四分位数范围11-115之间）发展为CPE感染，每10000 LT接受天发生3.05例病例，且在研究期间无显着增加（IRR 1.11） ，95％CI 0.98–1.26）。在多变量分析中，LT时CPE定植（危险比（HR）18.50，95％CI 6.76–50.54）和LT后获得CPE定植（HR 16.89，95％CI 6.95–41.00）是CPE感染的最强危险因素。联合移植（HR 2.60，95％CI 1.20–5.59），

结论

CPE在LT上定植或在LT后获得是CPE感染的最强预测因子。应研究针对以CPE定植的LT候选者和接受者为重点的预防策略。