Treatment of multidrug-resistant gram-negative bacilli after solid organ transplant: Outcomes and complications

Madeleine R. Heldman, Kexin Guo, Brett Nelson, Tenzin Babu, Michael G. Ison*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Infections caused by multidrug-resistant gram-negative bacilli (GNB) cause significant morbidity and mortality in solid organ transplant (SOT) recipients. Methods: We retrospectively collected data from all SOT recipients at a single center from 1 January 2007 to 15 April 2017 treated for infections caused by multi-drug-resistant GNB. This study examined the effects of specific antibiotics on nephrotoxicity, neurotoxicity, 30-day mortality, and length of stay in the hospital and intensive care unit. Results: A total of 225 infections were identified among 143 patients. Carbapenem-sensitive organisms were present in 112 (49.8%) infections and were associated with decreased 30-day mortality (OR 0.35, 95% CI 0.16-0.75). Neurotoxicity was associated with polymyxin use with an 8% increase in odds of neurotoxicity per day of exposure (P=.03). There was no relationship between nephrotoxicity and any individual antibiotic class. Increased hospital length-of-stay occurred among patients exposed to aminoglycosides (β-statistic = 0.48 (0.23); P =.04), while there was no relationship between antibiotic class and intensive care unit (ICU) length-of-stay. Mortality at 30 days occurred in 37 infections (16%). Carbapenem exposure was associated with decreased 30-day mortality (OR 0.93; 95% CI 0.90-0.98; P =.02). No other antibiotic class had a significant impact on 30-day mortality. Conclusions: Carbapenems appear to be a safe and effective treatment for solid-organ transplant recipients with infections caused by carbapenem-sensitive multidrug-resistant GNB; treatment of carbapenem-resistant gram-negatives remains challenging.

Original languageEnglish (US)
JournalTransplant Infectious Disease
DOIs
StateAccepted/In press - 2020

Keywords

  • antibiotic
  • bacterial infections
  • complications
  • resistance

ASJC Scopus subject areas

  • Infectious Diseases
  • Transplantation

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