학술논문
Colonization with multidrug-resistant organisms is associated with in increased mortality in liver transplant candidates.
Document Type
Article
Author
Ferstl, Philip G.; Filmann, Natalie; Heilgenthal, Eva-Maria; Schnitzbauer, Andreas A.; Bechstein, Wolf O.; Kempf, Volkhard A. J.; Villinger, David; Schultze, Tilman G.; Hogardt, Michael; Stephan, Christoph; Mutlak, Haitham; Weiler, Nina; Mücke, Marcus M.; Trebicka, Jonel; Zeuzem, Stefan; Waidmann, Oliver; Welker, Martin-Walter
Source
Subject
*LIVER transplantation
*CARBAPENEM-resistant bacteria
*METHICILLIN-resistant staphylococcus aureus
*COLONIZATION
*GRAM-negative bacteria
*MULTIDRUG-resistant tuberculosis
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Language
ISSN
1932-6203
Abstract
Objectives: Rising prevalence of multidrug-resistant organisms (MDRO) is a major health problem in patients with liver cirrhosis. The impact of MDRO colonization in liver transplantation (LT) candidates and recipients on mortality has not been determined in detail. Methods: Patients consecutively evaluated and listed for LT in a tertiary German liver transplant center from 2008 to 2018 underwent screening for MDRO colonization including methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant gram-negative bacteria (MDRGN), and vancomycin-resistant enterococci (VRE). MDRO colonization and infection status were obtained at LT evaluation, planned and unplanned hospitalization, three months upon graft allocation, or at last follow-up on the waiting list. Results: In total, 351 patients were listed for LT, of whom 164 (47%) underwent LT after a median of 249 (range 0–1662) days. Incidence of MDRO colonization increased during waiting time for LT, and MRDO colonization was associated with increased mortality on the waiting list (HR = 2.57, p<0.0001. One patients was colonized with a carbapenem-resistant strain at listing, 9 patients acquired carbapenem-resistant gram-negative bacteria (CRGN) on the waiting list, and 4 more after LT. In total, 10 of these 14 patients died. Conclusions: Colonization with MDRO is associated with increased mortality on the waiting list, but not in short-term follow-up after LT. Moreover, colonization with CRGN seems associated with high mortality in liver transplant candidates and recipients. [ABSTRACT FROM AUTHOR]