Year 2023 / Volume 115 / Number 7
Original
Implementation and impact of an antibiotic control program and multidrug-resistant bacterial colonization in a liver transplant unit

357-361

DOI: 10.17235/reed.2022.8810/2022

Ainhoa Fernández, Clara Díez-Picazo, Carmen Iglesias Sobrino, Celia Trueba Collado, Mario Romero Cristóbal, Fernando Díaz Fontenla, Aránzazu Caballero Marcos, Maricela Valerio, María Olmedo, Teresa Vicente Rangel, Belén Padilla Ortega, Rafael Ramos, José Ángel López Baena, Patricia Muñoz, Rafael Bañares, Magdalena Salcedo,

Abstract
Introduction: infections by multidrug-resistant bacteria are a major cause of morbidity and mortality in transplant patients. Objective: a retrospective single-center study was performed to evaluate the implementation of an Antimicrobial Treatment Optimization Program (PROA) on multidrug-resistant bacteria colonization and infection after liver transplant (LT). Methods: colonization by multidrug-resistant bacteria and infections during the first year after a liver transplant were analyzed in a group of 76 transplanted patients in two stages, before and after PROA (2016-2019). Clinical variables related to infection, readmissions and survival one year after the liver transplant were analyzed. Results: there was good adherence to the PROA. Infection was the most frequent cause for readmission during the first year after the liver transplant. Incidence of infections was similar during both periods (mean of 1.25 and 1.5 episodes of bacterial infection per patient/year, respectively) with 19 bacterial infectious episodes, six by hospital-acquired multidrug-resistant and extensively drug-resistant (MDR-XDR) bacteria in the pre-PROA stage, and 18 bacterial infectious episodes, five by MDR-XDR in the post-PROA stage. A 37 % decrease of post-TH of rectal colonization by MDR-XDR after liver transplant was observed during 2019. Conclusions: epidemiological surveillance policies and antibiotic optimization are key to control the increase of colonization and infection by multidrug-resistant bacteria in liver transplant units. Long-term studies are needed to better evaluate the impact of these programs.
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References
1. Cinar G, Kalkan İ, Azap A et al. Carbapenemase-Producing Bacterial Infections in Patients With Liver Transplant. Transplantation Proceedings. 2019;51(7):2461–65.
2. Kim IK, Park JS, Ju MK. Impact of Pre-Transplant Bacterial Infections on Post-Operative Outcomes in Patients after Liver Transplantation. Surg Infect (Larchmt).2017;18(2):170–175
3. Russell DL, Flood A, Zaroda TE et al. Outcomes of Colonization with MRSA and VRE among liver transplant candidates and recipients. Am J of Transplant. 2008;8(8):1737–43.
4. Richter SS, Marchaim D. Cribado for carbapenem-resistant Enterobacteriaceae: Who, When, and How? Virulence. 2017;8(4):417–26.
5. Red Nacional de Vigilancia Epidemiológica. Protocolo de vigilancia y control de microorganismos multirresistentes o de especial relevancia clínico-epidemiológica.
6. Oteo J, Calbo E, Rodríguez-Baño J et al. La amenaza de las enterobacterias productoras de carbapenemasas en España: documento de posicionamiento de los grupos de estudio GEIH y GEMARA de la SEIMC. Enferm Infecc Microbiol Clin. 2014;32(10):666-670.
7. Mòdol Deltell J, Álvarez Martins M, Méndez Hernández M. Política de antibióticos: irrupción de los programas de optimización del uso de antimicrobianos (PROA). Medicina Clínica. 2018;150(11):443–9.
8.Hsueh PR, Chen WH, Luh KT. Relationships between antimicrobial use and antimicrobial resistance in Gram-negative bacteria causing nosocomial infections from 1991-2003 at a university hospital in Taiwan. Int J Antimicrob Agents. 2005;26:463-72
9. Fernández J, Prado V, Trbicka J et al. Multidrug-resistant bacterial infections in patients with decompensated cirrhosis and with acute-on-chronic liver failure in Europe. J Hepatol.2019; 70(3):398-411
10. Nguyen MH, Shields RK, Chen L et al. Molecular epidemiology, natural history and long-term outcomes of multi-drug resistant Enterobacterales colonization and infections among solid organ transplant recipients. Clin Infect Dis 2022 Feb 11;74(3):395-406
11. Rodríguez-Baño J, Paño-Pardo J, Alvarez-Rocha L et al.Programas de optimización de uso de antimicrobianos (PROA) en hospitales españoles: documento de consenso GEIH-SEIMC, SEFH y SEMPSPH. Enferm Infecc Microbiol Clin. 2012;30(1):22.e1-22e23.
12. Kanj SS, Sharara AI, Clavien PA et al. Cytomegalovirus infection following liver transplantation: review of the literature. Clin Infect Dis. 1996;22(3):537-49.
13.-https://www.ecdc.europa.eu/en/publications-data/surveillance-antimicrobial-resistance-europe-2019.
14. Piano S, Singh V, Caraceni P et al. Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide. Gastroenterol. 2019;156(5):1368-1380.
15. Miranda-Zazueta G, León-Garduño LA, Aguirre-Valadez J et al. Bacterial infections in cirrhosis: Current treatment. Annals of Hepatology. 2020;19(3):238-244
16. Giannella M, Freire M, Rinaldi M et al. Development of a Risk Prediction Model for Carbapenem-Resistant Enterobacteriaceae Infection after Liver Transplantation: A Multinational Cohort Study. Clin Infect Dis. 2021;73(4):e955-e966
17.-https://www.ecdc.europa.eu/en/publications-data/directory-online-resources-prevention-and-control-antimicrobial-resistance-amr.
18. Colonna JO, Wiston DJ, Brill JE et al. Infectious Complications in Liver Transplantation. Arch Surg. 1988;123(3):360–4.
2016. Disponible en: https://www.comunidad.madrid/sites/default/files/doc/sanidad/epid/protocolommr.
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Fernández A, Díez-Picazo C, Iglesias Sobrino C, Trueba Collado C, Romero Cristóbal M, Díaz Fontenla F, et all. Implementation and impact of an antibiotic control program and multidrug-resistant bacterial colonization in a liver transplant unit. 8810/2022


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Publication history

Received: 22/03/2022

Accepted: 19/04/2022

Online First: 31/05/2022

Published: 06/07/2023

Article Online First time: 70 days

Article editing time: 471 days


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