Utilization of a Large, Multi-organizational Database for Clinical Monitoring and Prognostications: Donor and Recipient Impact of Multi-Drug Resistant Organisms in Transplant

A multi-drug resistant organism (MDRO) is a microorganism (bacteria, virus, fungus, etc.) that is resistant to multiple classes of antimicrobial agents.[1] Since the 1960's, infections with multi-drug resistant organisms have been steadily increasing, particularly in health are settings.(2, 3] In addition to developing clinical infection, patients can also become colonized with MDRO. In colonization, a person carries the MDRO and can transmit it to other people, but shows no clinical signs or symptoms of the infection; patients colonized with MDRO are at increased risk of developing clinically significant MDRO infections. Patients that are particularly vulnerable lo colonization and infection with MDRO include those with multiple medical co-morbidities, recurrent or prolonged hospitalizations, compromised immune system, recent surgery, and indwelling medical devices.(4] In transplant recipients, infections remain a common cause of morbidity and mortality, and traits of both end stage organ disease sequelae of organ transplantation make transplant patients particularly vulnerable to both colonization and infection with MDROs.[5] Further, MDRO's are responsible for the majority of donor-derived bacterial transmission events based on Organ Procurement and Transplant Network (OPTN) data. Although significant progress has been made in reducing the rate of infection following transplantation, relatively fewer efforts have been aimed at addressing the risk of transmission of donor-derived infection.{6] Also, no studies have examined the influence of donor colonization with MDRO on transplant recipient outcomes. Therefore, we aim to better understand the epidemiology and risks of donor colonization with MDRO with our proposed study. We hypothesize that donor colonization with MDRO results in higher rates of transplant recipient post-transplant infections, thus adversely affecting graft and patient outcome. Specific Aim 1: To join a self-loading instance of the Gift of Hope (GOH) Enterprise Data Warehouse, the• Northwestern Medicine Enterprise Data Warehouse (EDW), and national registry data (United Network for Organ Sharing (UNOS), United States Renal Data System (USRDS), and Scientific Registry of Transplant Recipients (SRTR)) at the individual patient level and produce a de-identified data mart suitable for exploratory data analysis. Aim 1.1 To implement inter-institutionalprotocols to securely extract, transform, and load GOH, EDW, UNOS, USRDS, and SRTR data on a regular basis. Aim 1.2. To implement auditing and logging diagnostics to insure correct loading of upstream data. Aim 1.3 To implement automated de-identification of joined data. We hypothesize that joining these 3 unique databases will allow for the association of novel donor characteristics with recipient outcomes. Specific Aim 2: To examine whether donor colonization or infection with a multi-drug resistant organism (MDRO) affects transplant recipient rate of post-transplant infection Aim 2.1 Quantify the rates of MDRO colonization as recorded in the GOH donor record and DonorNet. Aim 2.2 Determine if donor colonization status is associated with donor covariates (e.g. hospital length of stay, ICU length of stay, age, patient's residence in a nursing home or correctional facility) Aim 2.3 Determine if donor colonization status is associated with transplant recipient outcomes (e.g. delayed graft function, post-transplant infection, and graft survival). We hypothesize that donor colonization or infection with MDRO results in increased