Incidence of carbapenem-resistant gram negatives in Italian transplant recipients: A nationwide surveillance study

Simone Lanini, Alessandro Nanni Costa, Vincenzo Puro, Francesco Procaccio, Paolo Antonio Grossi, Francesca Vespasiano, Andrea Ricci, Sergio Vesconi, Michael G. Ison, Yehuda Carmeli, Giuseppe Ippolito

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Article numbere0123706
JournalPloS one
Volume10
Issue number4
DOIs
StatePublished - Apr 2 2015

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carbapenems
Transplants
Carbapenems
Gram-Negative Bacteria
Gram-negative bacteria
Bacteria
incidence
monitoring
Incidence
organ transplantation
Length of Stay
Transplantation
lungs
Lung
Mortality
heart
Transplant Recipients
Transplantation (surgical)
Epidemiology
Klebsiella

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Lanini, S., Costa, A. N., Puro, V., Procaccio, F., Grossi, P. A., Vespasiano, F., ... Ippolito, G. (2015). Incidence of carbapenem-resistant gram negatives in Italian transplant recipients: A nationwide surveillance study. PloS one, 10(4), [e0123706]. https://doi.org/10.1371/journal.pone.0123706
Lanini, Simone ; Costa, Alessandro Nanni ; Puro, Vincenzo ; Procaccio, Francesco ; Grossi, Paolo Antonio ; Vespasiano, Francesca ; Ricci, Andrea ; Vesconi, Sergio ; Ison, Michael G. ; Carmeli, Yehuda ; Ippolito, Giuseppe. / Incidence of carbapenem-resistant gram negatives in Italian transplant recipients : A nationwide surveillance study. In: PloS one. 2015 ; Vol. 10, No. 4.
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title = "Incidence of carbapenem-resistant gram negatives in Italian transplant recipients: A nationwide surveillance study",
abstract = "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.",
author = "Simone Lanini and Costa, {Alessandro Nanni} and Vincenzo Puro and Francesco Procaccio and Grossi, {Paolo Antonio} and Francesca Vespasiano and Andrea Ricci and Sergio Vesconi and Ison, {Michael G.} and Yehuda Carmeli and Giuseppe Ippolito",
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Lanini, S, Costa, AN, Puro, V, Procaccio, F, Grossi, PA, Vespasiano, F, Ricci, A, Vesconi, S, Ison, MG, Carmeli, Y & Ippolito, G 2015, 'Incidence of carbapenem-resistant gram negatives in Italian transplant recipients: A nationwide surveillance study', PloS one, vol. 10, no. 4, e0123706. https://doi.org/10.1371/journal.pone.0123706

Incidence of carbapenem-resistant gram negatives in Italian transplant recipients : A nationwide surveillance study. / Lanini, Simone; Costa, Alessandro Nanni; Puro, Vincenzo; Procaccio, Francesco; Grossi, Paolo Antonio; Vespasiano, Francesca; Ricci, Andrea; Vesconi, Sergio; Ison, Michael G.; Carmeli, Yehuda; Ippolito, Giuseppe.

In: PloS one, Vol. 10, No. 4, e0123706, 02.04.2015.

Research output: Contribution to journalArticle

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

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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