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

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Heldman, MR; Guo, K; Nelson, B; Babu, T; Ison, MG

Published Date

  • February 2021

Published In

Volume / Issue

  • 23 / 1

Start / End Page

  • e13474 -

PubMed ID

  • 32978863

Pubmed Central ID

  • PMC9435024

Electronic International Standard Serial Number (EISSN)

  • 1399-3062

Digital Object Identifier (DOI)

  • 10.1111/tid.13474

Language

  • eng

Conference Location

  • Denmark