A systematic review and meta-analysis shows that colonization with multidrug-resistant (MDR) organisms is associated with increased risk of death and infection in solid-organ transplant (SOT) recipients, researchers reported yesterday in Clinical Microbiology and Infection.
The review by researchers at the University of Alberta identified 39 studies that reported on outcomes in adult SOT recipients who were colonized by methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE), extended-spectrum beta lactamase (ESBL)–producing or carbapenem-resistant Enterobacterales (CRE), and MDR Pseudomonas and compared them to outcomes in non-colonized SOT recipients. Outcomes included mortality, infection, and graft-loss.
Increased risk of death, infections
The 39 studies included 15,202 SOT recipients, of whom 4,077 (27%) were colonized with MDR bacteria. Nearly half of the patients received liver transplants. MDR colonization was associated with significantly increased post-transplant 1-year mortality (odds ratio [OR], 2.35; 95% confidence interval [CI], 1.63 to 3.38) and mixed infections (OR, 10.47; 95% CI, 7.56 to 12.26) across transplant types, but there was no detected impact on graft loss (OR, 1.17; 95% CI, 0.81 to 1.69).
Subgroup analyses found that the highest mortality risk was in SOT recipients colonized by CRE (OR, 3.94; 95% CI, 1.86 to 8.37), followed by VRE (OR, 3.65; 95% CI, 2.17 to 6.11) and MRSA (OR, 2.25; 95% CI, 1.25 to 4.05). The highest risk for infection was in patients colonized by CRE (OR, 19.57; 95% CI, 7.78 to 49.28) and ESBL (OR, 9.09; 95% CI, 5.59 to 14.78).
The study authors acknowledge that SOT recipients with MDR colonization may be more ill, which could explain the increased risk of death. But they say the findings could contribute to development of guidelines for MDR-colonized SOT candidates.
"Our study highlights the burden of MDR colonization in SOT and can aid in stratifying the recipient's risk of infection and mortality according to type of MDR colonization," they wrote. "Whether pre-transplant decolonization strategies may improve the prognosis of SOT patients should be evaluated in prospective studies."