Evaluation of extensively drug-resistant gram-negative bacteremia among solid-organ transplant recipients: a multicenter study

Background/aim: The aim of this study is to evaluate the distribution, sources, clinical features, and mortality rates of bacteremia due to evaluation of extensively drug-resistant (XDR) gram negative among solid-organ transplant (SOT) recipients. Materials and methods: A retrospective study of SOT recipients with bacteremia due to XDR gram-negative pathogens in 11 centers between 2016 and 2018 was conducted. Patients’ records were evaluated. Results: Of 171 bacteremia that occurred in 164 SOT recipients, 93 (56.7%) were liver, 46 (28%) kidney, 14 (8.5%) heart, and 11 (6.7%) lung recipients. Bacteremia episodes were recorded in the first year in 63.7% of the patients (n = 109), early-onset bacteremia was recorded in 45% (n = 77) of the episodes. In multivariate analysis, catheter-associated bacteremia was an independent risk factor for 7-day mortality (p = 0.037), and early-onset bacteremia was found as an independent risk factor for 30-day mortality (p = 0.017). Conclusion: Difficult-to-treat infections due to XDR bacteria in SOT recipients shadow the success of transplantation. Central venous catheters seem to be the main risk factor. Judicious use of medical devices is of pivotal importance.Key words: Solid-organ transplant recipients, drug-resistant, bacteremia

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1. Bartoletti M, Giannella M, Tedeschi S, Viale P. Multidrugresistant bacterial infections in solid organ transplant candidates and recipients. Infectious Disease Clinics of North America 2018; 32 (3): 551-580. doi: 10.1016/j.idc.2018.04.004
2. Singh N, Limaye AP. Infections in solid-organ transplant recipients. In: Mandell GL, Bennett JE, Dolin R (editors). Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. Updated ed. Philadelphia, PA, USA: Churchill Livingstone; 2019. pp. 3440-3452
3. Qiao B, Wu J, Wan Q, Zhang S, Ye Q. Factors influencing mortality in abdominal solid organ transplant recipients with multidrug-resistant gram-negative bacteremia. BMC infectious diseases 2017; 17 (1): 171. doi: 10.1186/s12879-017-2276-1
4. Oriol I, Sabe N, Simonetti AF, Llado L, Manonelles A et al. Changing trends in the aetiology, treatment and outcomes of bloodstream infection occurring in the first year after solid organ transplantation: a single-centre prospective cohort study. Transplant International 2017; 30 (9): 903-913. doi: 10.1111/ tri.12984
5. Shendi AM, Wallis G, Painter H, Harber M, Collier S. Epidemiology and impact of bloodstream infections among kidney transplant recipients: A retrospective single-center experience. Transplant Infectious Disease 2018; 20 (1). doi: 10.1111/tid.12815
6. Serefhanoğlu K, Timurkaynak F, Arslan H, Karakayalı H. Bacteremia among liver and kidney transplant recipients: etiologic agents and antimicrobial susceptibilities. Brazilian Journal of Infectious Diseases 2011; 15 (4): 408-409. doi: 10.1016/S1413-8670 (11)70218-5
7. Al-Hasan MN, Razonable RR, Eckel-Passow JE, Baddour LM. Incidence rate and outcome of gram-negative bloodstream infection in solid organ transplant recipients. American Journal of Transplantation 2009; 9 (4): 835-843. doi: 10.1111/j.1600- 6143.2009.02559.x
8. Candel FJ, Grima E, Matesanz M, Cervera C, Soto G et al. Bacteremia and septic shock after solid-organ transplantation. Transplantation Proceedings 2005; 37 (9): 4097-4099. doi: 10.1016/j.transproceed.2005.09.181
9. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clinical Microbiology and Infection 2012; 18 (3): 268-281. doi: 10.1111/j.1469-0691.2011.03570.x
10. Timsit JF, Sonneville R, Kalil AC, Bassetti M, Ferrer R et al. Diagnostic and therapeutic approach to infectious diseases in solid organ transplant recipients. Intensive Care Medicine 2019; 45 (5): 573-591. doi: 10.1007/s00134-019-05597-y
11. Pouch SM, Patel G. Multidrug-resistant gram-negative bacterial infections in solid organ transplant recipients-Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clinical Transplantation 2019; 33 (9): e13594. doi: 10.1111/ctr.13594
12. O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J et al. Guidelines for the prevention of intravascular catheterrelated infections. Clinical Infectious Diseases 2011; 52 (9): e162-193. doi: 10.1093/cid/cir257
13. Shields RK, Clancy CJ, Gillis LM, Kwak EJ, Silveira FP et al. Epidemiology, clinical characteristics and outcomes of extensively drug-resistant Acinetobacter baumannii infections among solid organ transplant recipients. PloS one 2012; 7 (12): e52349. doi: 10.1371/journal.pone.0052349
14. Bodro M, Sabe N, Tubau F, Llado L, Baliellas C et al. Risk factors and outcomes of bacteremia caused by drug-resistant ESKAPE pathogens in solid-organ transplant recipients. Transplantation 2013; 96 (9): 843-849. doi: 10.1097/TP.0b013e3182a049fd
15. Mazza E, Prosperi M, Panzeri MF, Limuti R, Nichelatti M, De Gasperi A. Carbapenem-resistant Klebsiella pneumoniae infections early after liver transplantation: a single-center experience. Transplantation proceedings 2017; 49 (4): 677-681. doi: 10.1016/j.transproceed.2017.02.028
16. Yeşilkaya A, Azap OK, Demirkaya MH, Ok MA, Arslan H, Akdur A. Bloodstream infections among solid organ transplant recipients: eight years’ experience from a Turkish university hospital. Balkan Medical Journal 2013; 30 (3): 282-286. doi: 10.5152/balkanmedj.2013.9256
17. Aguado JM, Silva JT, Fernandez-Ruiz M, Cordero E, Fortun J et al. Management of multidrug resistant gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRASEIMC/REIPI recommendations. Transplantation Reviews 2018; 32 (1): 36-57. doi: 10.1016/j.trre.2017.07.001
18. Massa E, Michailidou E, Agapakis D, Papadopoulos S, Tholioti T et al. Colonization and infection with extensively drug resistant gram-negative bacteria in liver transplant recipients. Transplantation Proceedings 2019; 51 (2): 454-456. doi: 10.1016/j.transproceed.2019.01.076

APA	yanık yalçın t, Azap Ö, Köse A, BAYINDIR Y, Sarıcaoğlu E, CINAR G, Uygun Kizmaz Y, Oruc E, ALISKAN H, Tezer-Tekçe A, EREN-KUTSOYLU O, Egeli T, ARI A, Albayrak Y, Çabadak H, ÖZTÜRK DENİZ S, demir önder k, Kizilates F, Ozger H, GUZEL TUNCCAN O, Haberal M (2021). Evaluation of extensively drug-resistant gram-negative bacteremia among solid-organ transplant recipients: a multicenter study. , 1960 - 1968. 10.3906/sag-2101-161
Chicago	yanık yalçın tuğba,Azap Özlem Kurt,Köse Adem,BAYINDIR Yasar,Sarıcaoğlu Elif mukime,CINAR GULE,Uygun Kizmaz Yesim,Oruc Ebru,ALISKAN HIKMET EDA,Tezer-Tekçe A.Yasemin,EREN-KUTSOYLU Oya Ozlem,Egeli Tufan,ARI ALPAY,Albayrak Yurdagül,Çabadak Hatice,ÖZTÜRK DENİZ SUNA SEÇİL,demir önder kübra,Kizilates Filiz,Ozger H.Selcuk,GUZEL TUNCCAN OZLEM,Haberal Mehmet Evaluation of extensively drug-resistant gram-negative bacteremia among solid-organ transplant recipients: a multicenter study. (2021): 1960 - 1968. 10.3906/sag-2101-161
MLA	yanık yalçın tuğba,Azap Özlem Kurt,Köse Adem,BAYINDIR Yasar,Sarıcaoğlu Elif mukime,CINAR GULE,Uygun Kizmaz Yesim,Oruc Ebru,ALISKAN HIKMET EDA,Tezer-Tekçe A.Yasemin,EREN-KUTSOYLU Oya Ozlem,Egeli Tufan,ARI ALPAY,Albayrak Yurdagül,Çabadak Hatice,ÖZTÜRK DENİZ SUNA SEÇİL,demir önder kübra,Kizilates Filiz,Ozger H.Selcuk,GUZEL TUNCCAN OZLEM,Haberal Mehmet Evaluation of extensively drug-resistant gram-negative bacteremia among solid-organ transplant recipients: a multicenter study. , 2021, ss.1960 - 1968. 10.3906/sag-2101-161
AMA	yanık yalçın t,Azap Ö,Köse A,BAYINDIR Y,Sarıcaoğlu E,CINAR G,Uygun Kizmaz Y,Oruc E,ALISKAN H,Tezer-Tekçe A,EREN-KUTSOYLU O,Egeli T,ARI A,Albayrak Y,Çabadak H,ÖZTÜRK DENİZ S,demir önder k,Kizilates F,Ozger H,GUZEL TUNCCAN O,Haberal M Evaluation of extensively drug-resistant gram-negative bacteremia among solid-organ transplant recipients: a multicenter study. . 2021; 1960 - 1968. 10.3906/sag-2101-161
Vancouver	yanık yalçın t,Azap Ö,Köse A,BAYINDIR Y,Sarıcaoğlu E,CINAR G,Uygun Kizmaz Y,Oruc E,ALISKAN H,Tezer-Tekçe A,EREN-KUTSOYLU O,Egeli T,ARI A,Albayrak Y,Çabadak H,ÖZTÜRK DENİZ S,demir önder k,Kizilates F,Ozger H,GUZEL TUNCCAN O,Haberal M Evaluation of extensively drug-resistant gram-negative bacteremia among solid-organ transplant recipients: a multicenter study. . 2021; 1960 - 1968. 10.3906/sag-2101-161
IEEE	yanık yalçın t,Azap Ö,Köse A,BAYINDIR Y,Sarıcaoğlu E,CINAR G,Uygun Kizmaz Y,Oruc E,ALISKAN H,Tezer-Tekçe A,EREN-KUTSOYLU O,Egeli T,ARI A,Albayrak Y,Çabadak H,ÖZTÜRK DENİZ S,demir önder k,Kizilates F,Ozger H,GUZEL TUNCCAN O,Haberal M "Evaluation of extensively drug-resistant gram-negative bacteremia among solid-organ transplant recipients: a multicenter study." , ss.1960 - 1968, 2021. 10.3906/sag-2101-161
ISNAD	yanık yalçın, tuğba vd. "Evaluation of extensively drug-resistant gram-negative bacteremia among solid-organ transplant recipients: a multicenter study". (2021), 1960-1968. https://doi.org/10.3906/sag-2101-161

APA	yanık yalçın t, Azap Ö, Köse A, BAYINDIR Y, Sarıcaoğlu E, CINAR G, Uygun Kizmaz Y, Oruc E, ALISKAN H, Tezer-Tekçe A, EREN-KUTSOYLU O, Egeli T, ARI A, Albayrak Y, Çabadak H, ÖZTÜRK DENİZ S, demir önder k, Kizilates F, Ozger H, GUZEL TUNCCAN O, Haberal M (2021). Evaluation of extensively drug-resistant gram-negative bacteremia among solid-organ transplant recipients: a multicenter study. Turkish Journal of Medical Sciences, 51(4), 1960 - 1968. 10.3906/sag-2101-161
Chicago	yanık yalçın tuğba,Azap Özlem Kurt,Köse Adem,BAYINDIR Yasar,Sarıcaoğlu Elif mukime,CINAR GULE,Uygun Kizmaz Yesim,Oruc Ebru,ALISKAN HIKMET EDA,Tezer-Tekçe A.Yasemin,EREN-KUTSOYLU Oya Ozlem,Egeli Tufan,ARI ALPAY,Albayrak Yurdagül,Çabadak Hatice,ÖZTÜRK DENİZ SUNA SEÇİL,demir önder kübra,Kizilates Filiz,Ozger H.Selcuk,GUZEL TUNCCAN OZLEM,Haberal Mehmet Evaluation of extensively drug-resistant gram-negative bacteremia among solid-organ transplant recipients: a multicenter study. Turkish Journal of Medical Sciences 51, no.4 (2021): 1960 - 1968. 10.3906/sag-2101-161
MLA	yanık yalçın tuğba,Azap Özlem Kurt,Köse Adem,BAYINDIR Yasar,Sarıcaoğlu Elif mukime,CINAR GULE,Uygun Kizmaz Yesim,Oruc Ebru,ALISKAN HIKMET EDA,Tezer-Tekçe A.Yasemin,EREN-KUTSOYLU Oya Ozlem,Egeli Tufan,ARI ALPAY,Albayrak Yurdagül,Çabadak Hatice,ÖZTÜRK DENİZ SUNA SEÇİL,demir önder kübra,Kizilates Filiz,Ozger H.Selcuk,GUZEL TUNCCAN OZLEM,Haberal Mehmet Evaluation of extensively drug-resistant gram-negative bacteremia among solid-organ transplant recipients: a multicenter study. Turkish Journal of Medical Sciences, vol.51, no.4, 2021, ss.1960 - 1968. 10.3906/sag-2101-161
AMA	yanık yalçın t,Azap Ö,Köse A,BAYINDIR Y,Sarıcaoğlu E,CINAR G,Uygun Kizmaz Y,Oruc E,ALISKAN H,Tezer-Tekçe A,EREN-KUTSOYLU O,Egeli T,ARI A,Albayrak Y,Çabadak H,ÖZTÜRK DENİZ S,demir önder k,Kizilates F,Ozger H,GUZEL TUNCCAN O,Haberal M Evaluation of extensively drug-resistant gram-negative bacteremia among solid-organ transplant recipients: a multicenter study. Turkish Journal of Medical Sciences. 2021; 51(4): 1960 - 1968. 10.3906/sag-2101-161
Vancouver	yanık yalçın t,Azap Ö,Köse A,BAYINDIR Y,Sarıcaoğlu E,CINAR G,Uygun Kizmaz Y,Oruc E,ALISKAN H,Tezer-Tekçe A,EREN-KUTSOYLU O,Egeli T,ARI A,Albayrak Y,Çabadak H,ÖZTÜRK DENİZ S,demir önder k,Kizilates F,Ozger H,GUZEL TUNCCAN O,Haberal M Evaluation of extensively drug-resistant gram-negative bacteremia among solid-organ transplant recipients: a multicenter study. Turkish Journal of Medical Sciences. 2021; 51(4): 1960 - 1968. 10.3906/sag-2101-161
IEEE	yanık yalçın t,Azap Ö,Köse A,BAYINDIR Y,Sarıcaoğlu E,CINAR G,Uygun Kizmaz Y,Oruc E,ALISKAN H,Tezer-Tekçe A,EREN-KUTSOYLU O,Egeli T,ARI A,Albayrak Y,Çabadak H,ÖZTÜRK DENİZ S,demir önder k,Kizilates F,Ozger H,GUZEL TUNCCAN O,Haberal M "Evaluation of extensively drug-resistant gram-negative bacteremia among solid-organ transplant recipients: a multicenter study." Turkish Journal of Medical Sciences, 51, ss.1960 - 1968, 2021. 10.3906/sag-2101-161
ISNAD	yanık yalçın, tuğba vd. "Evaluation of extensively drug-resistant gram-negative bacteremia among solid-organ transplant recipients: a multicenter study". Turkish Journal of Medical Sciences 51/4 (2021), 1960-1968. https://doi.org/10.3906/sag-2101-161