Multidrug-resistant organism bloodstream infections in solid organ transplant recipients and impact on mortality: a systematic review.

IF 3.7 Q2 INFECTIOUS DISEASES
JAC-Antimicrobial Resistance Pub Date : 2024-10-09 eCollection Date: 2024-10-01 DOI:10.1093/jacamr/dlae152
Alice J Liu, Adelaide S M Dennis, Zarin Fariha, Rekha Pai Mangalore, Nenad Macesic
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Abstract

Background: Bloodstream infections (BSIs) cause significant morbidity and mortality in solid organ transplant (SOT) recipients. There are few data regarding the contribution of MDR organisms (MDROs) to these infections. We evaluated the resistance percentage of MDRO BSIs in SOT recipients and the associated mortality.

Methods: A systematic review of MEDLINE and Embase databases up to January 2024, for studies of adult SOT recipients that quantified MDRO BSI resistance percentage and/or associated crude mortality. MDROs studied were carbapenem-resistant Enterobacterales (CRE), Acinetobacter baumannii (CRAB) and Pseudomonas aeruginosa (CRPA), third-generation cephalosporin-resistant Enterobacterales (3GCR-E), MRSA and VRE. Resistance percentage and mortality outcomes were reported as median (IQR) and crude mortality (%), respectively.

Results: Of 945 studies identified, 52 were included. Most were retrospective (41/52) and/or single centre (37/52), and liver transplantation was the most frequently studied SOT type (22/52). High resistance percentages of BSIs were noted, ranging from 13.6% CRE for Enterobacterales to 59.2% CRAB for A. baumannii. Resistance percentage trends decreased over time, but these changes were not statistically significant. Asia had the highest resistance percentages for MRSA [86.2% (IQR 77.3%-94.6%)], 3GCR-E [59.5% (IQR 40.5%-66.7%)] and CRE [35.7% (IQR 8.3%-63.1%)]. North America had the highest VRE resistance percentages [77.7% (IQR 54.6%-94.7%)]. Crude mortality was 15.4%-82.4% and was consistently higher than for non-MDRO BSIs.

Conclusions: MDRO BSI resistance percentages were high for all pathogens studied (IQR 24.6%-69.4%) but there was geographical and temporal heterogeneity. MDRO BSIs were associated with high mortality in SOT recipients. Microbiological and clinical data in this vulnerable population were incomplete, highlighting the need for robust international multicentre studies.

实体器官移植受者耐多药生物体血流感染及其对死亡率的影响:系统综述。
背景:在实体器官移植(SOT)受者中,血流感染(BSI)会导致严重的发病率和死亡率。有关MDR菌(MDRO)对这些感染的贡献的数据很少。我们评估了MDRO BSIs在SOT受者中的耐药性比例以及相关死亡率:方法:对MEDLINE和Embase数据库中截至2024年1月的研究进行系统性回顾,研究对象为成人SOT受者,这些研究量化了MDRO BSI耐药率和/或相关的粗死亡率。研究的MDRO包括耐碳青霉烯类肠杆菌(CRE)、鲍曼不动杆菌(CRAB)和铜绿假单胞菌(CRPA)、耐第三代头孢菌素肠杆菌(3GCR-E)、MRSA和VRE。耐药率和死亡率结果分别以中位数(IQR)和粗死亡率(%)表示:在确定的 945 项研究中,有 52 项被纳入。大多数为回顾性研究(41/52)和/或单中心研究(37/52),肝移植是最常研究的 SOT 类型(22/52)。BSIs 的耐药率很高,从肠杆菌的 13.6% CRE 到鲍曼不动杆菌的 59.2% CRAB 不等。随着时间的推移,耐药性百分比呈下降趋势,但这些变化在统计学上并不显著。亚洲对 MRSA [86.2% (IQR 77.3%-94.6%)] 、3GCR-E [59.5% (IQR 40.5%-66.7%)] 和 CRE [35.7% (IQR 8.3%-63.1%)] 的耐药率最高。北美洲的 VRE 耐药率最高[77.7%(IQR 54.6%-94.7%)]。粗死亡率为 15.4%-82.4%,始终高于非 MDRO BSI:结论:在研究的所有病原体中,MDRO BSI 耐药率较高(IQR 24.6%-69.4%),但存在地域和时间异质性。MDRO BSI与SOT受者的高死亡率有关。这一易感人群的微生物学和临床数据并不完整,因此需要进行强有力的国际多中心研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.30
自引率
0.00%
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审稿时长
16 weeks
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