TY - JOUR
T1 - Incidence of carbapenem-resistant gram negatives in Italian transplant recipients
T2 - A nationwide surveillance study
AU - Lanini, Simone
AU - Costa, Alessandro Nanni
AU - Puro, Vincenzo
AU - Procaccio, Francesco
AU - Grossi, Paolo Antonio
AU - Vespasiano, Francesca
AU - Ricci, Andrea
AU - Vesconi, Sergio
AU - Ison, Michael G.
AU - Carmeli, Yehuda
AU - Ippolito, Giuseppe
N1 - Funding Information:
Yehuda Carmeli, received grants, honoraria, travel support, consulting fees, and other forms of financial support. Paolo Antonio Grossi received grants, honoraria, travel support, consulting fees, and other forms of financial support from Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, Janssen-Cilag, Merck Sharp & Dohme, Novartis, Pfizer, Roche.Michel G Ison: received research support from Anolinx, Cellex, Chimerix, Crucell, GlaxoSmithKlein, NexBio and ViroPharma; provided paid consultation to Alios, Abbott, Crucell and Genentech/Roche; provided unpaid consultation to Adamas, BioCryst, Biota, Cellex, Clarassance, GlaxoSmithKlein, GenMarkDx, Romark, Toyama/MediVector, NexBio, Theraclone, Vertex and Visterra; participated to data and safety monitoring board for Biota and NexBio. The other authors declare that they have no competing interests. This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials.
Funding Information:
DRIn study has been approved by Ethical Committee of the Italian Health Institute (ref CE/13/382) in the framework of the national surveillance programme funded by the Italian Ministry Health. All SOT recipients signed a general consent at the time of inclusion in the waiting list. This informed consent includes acceptance of: policies for management of personal information; transplant and associated procedures; procedures for data collection and data management; policies for organs allocation and system for post-transplant surveillance. A specific consent for this study was not required as: a) information at enrollment were obtained through a mandatory national database (established by law 91/1999) which collects donors and recipients data; b)personal information was anonymized and de-identified prior to analysis; c) no intervention was planned for the purpose of the study and patients underwent medical intervention (including diagnostics) according to clinical guidelines and Italian regulations for safety and quality in solid organ transplantation.
Publisher Copyright:
Copyright: © 2015 Lanini et al.
PY - 2015/4/2
Y1 - 2015/4/2
N2 - Background: Bacterial infections remain a challenge to solid organ transplantation. Due to the alarming spread of carbapenem-resistant gram negative bacteria, these organisms have been frequently recognized as cause of severe infections in solid organ transplant recipients. Methods and Findings: Between 15 May and 30 September 2012 we enrolled 887 solid organ transplant recipients in Italy with the aim to describe the epidemiology of gram negative bacteria spreading, to explore potential risk factors and to assess the effect of early isolation of gram negative bacteria on recipients' mortality during the first 90 days after transplantation. During the study period 185 clinical isolates of gram negative bacteria were reported, for an incidence of 2.39 per 1000 recipient-days. Positive cultures for gram negative bacteria occurred early after transplantation (median time 26 days; incidence rate 4.33, 1.67 and 1.14 per 1,000 recipientdays in the first, second and third month after SOT, respectively). Forty-nine of these clinical isolates were due to carbapenem-resistant gram negative bacteria (26.5%; incidence 0.63 per 1000 recipient-days). Carbapenems resistance was particularly frequent among Klebsiella spp. isolates (49.1%). Recipients with longer hospital stay and those who received either heart or lung graft were at the highest risk of testing positive for any gram negative bacteria. Moreover recipients with longer hospital stay, lung recipients and those admitted to hospital for more than 48h before transplantation had the highest probability to have culture(s) positive for carbapenem-resistant gram negative bacteria. Forty-four organ recipients died (0.57 per 1000 recipient-days) during the study period. Recipients with at least one positive culture for carbapenem-resistant gram negative bacteria had a 10.23-fold higher mortality rate than those who did not. Conclusion: The isolation of gram-negative bacteria is most frequent among recipient with hospital stays >48 hours prior to transplant and in those receiving either heart or lung transplants. Carbapenemresistant gram negative isolates are associated with significant mortality.
AB - Background: Bacterial infections remain a challenge to solid organ transplantation. Due to the alarming spread of carbapenem-resistant gram negative bacteria, these organisms have been frequently recognized as cause of severe infections in solid organ transplant recipients. Methods and Findings: Between 15 May and 30 September 2012 we enrolled 887 solid organ transplant recipients in Italy with the aim to describe the epidemiology of gram negative bacteria spreading, to explore potential risk factors and to assess the effect of early isolation of gram negative bacteria on recipients' mortality during the first 90 days after transplantation. During the study period 185 clinical isolates of gram negative bacteria were reported, for an incidence of 2.39 per 1000 recipient-days. Positive cultures for gram negative bacteria occurred early after transplantation (median time 26 days; incidence rate 4.33, 1.67 and 1.14 per 1,000 recipientdays in the first, second and third month after SOT, respectively). Forty-nine of these clinical isolates were due to carbapenem-resistant gram negative bacteria (26.5%; incidence 0.63 per 1000 recipient-days). Carbapenems resistance was particularly frequent among Klebsiella spp. isolates (49.1%). Recipients with longer hospital stay and those who received either heart or lung graft were at the highest risk of testing positive for any gram negative bacteria. Moreover recipients with longer hospital stay, lung recipients and those admitted to hospital for more than 48h before transplantation had the highest probability to have culture(s) positive for carbapenem-resistant gram negative bacteria. Forty-four organ recipients died (0.57 per 1000 recipient-days) during the study period. Recipients with at least one positive culture for carbapenem-resistant gram negative bacteria had a 10.23-fold higher mortality rate than those who did not. Conclusion: The isolation of gram-negative bacteria is most frequent among recipient with hospital stays >48 hours prior to transplant and in those receiving either heart or lung transplants. Carbapenemresistant gram negative isolates are associated with significant mortality.
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U2 - 10.1371/journal.pone.0123706
DO - 10.1371/journal.pone.0123706
M3 - Article
C2 - 25835018
AN - SCOPUS:84926660821
VL - 10
JO - PLoS One
JF - PLoS One
SN - 1932-6203
IS - 4
M1 - e0123706
ER -