Colonization and infection due to carbapenemase-producing Enterobacteriaceae in liver and lung transplant recipients and donor-derived transmission: a prospective cohort study conducted in Italy

被引：43

作者：

Errico, G. ^{[1
]}

Gagliotti, C. ^{[4
]}

Monaco, M. ^{[1
]}

Masiero, L. ^{[2
]}

Gaibani, P. ^{[5
]}

Ambretti, S. ^{[5
]}

Landini, M. P. ^{[5
,8
]}

D'Arezzo, S. ^{[3
]}

Di Caro, A. ^{[3
]}

Parisi, S. G. ^{[6
]}

Palu, G. ^{[6
]}

Vespasiano, F. ^{[2
]}

Morsillo, F. ^{[4
]}

Moro, M. L. ^{[4
]}

Procaccio, F. ^{[2
]}

Ricci, A. ^{[2
]}

Grossi, P. A. ^{[7
]}

Pantosti, A. ^{[1
]}

Costa, A. Nanni ^{[2
]}

Farina, C. ^{[9
]}

Vailati, F. ^{[9
]}

Gesu, G. ^{[10
]}

Vismara, C. ^{[10
]}

Arghittu, M. ^{[11
]}

Colombo, R. ^{[11
]}

Torresani, E. ^{[11
]}

Rossi, L. ^{[12
]}

Conaldi, P. G. ^{[13
]}

Gona, F. ^{[13
]}

Cambieri, P. ^{[14
]}

Marone, P. ^{[14
]}

Venditti, C. ^{[15
]}

Garcia-Fernandez, A. ^{[16
]}

Mancini, C. ^{[17
]}

Cusi, M. ^{[18
]}

De Angelis, L. Henrici ^{[18
]}

Fossati, L. ^{[19
]}

Finarelli, A. C. ^{[20
]}

De Cillia, C. ^{[21
]}

Sangiorgi, G. ^{[21
]}

Pinna, A. D. ^{[22
]}

Stella, F. ^{[22
]}

Viale, P. ^{[22
]}

Colledan, M. ^{[23
]}

Platto, M. ^{[23
]}

Bonizzoli, M. ^{[24
]}

Peris, A. ^{[24
]}

Torelli, R. ^{[25
]}

Vesconi, S. ^{[25
]}

Cibelli, E. ^{[26
]}

机构：

[1] Ist Super Sanita, Dipartimento Malattie Infett, Viale Regina Elena 299, Rome, Italy

[2] Ist Super Sanita, Ctr Nazl Trapianti, Rome, Italy

[3] Ist Nazl Malattie Infett L Spallanzani IRCCS, Rome, Italy

[4] Agenzia Sanit & Sociale Reg Emilia Romagna, Bologna, Italy

[5] Policlin St Orsola Malpighi, Unita Operat Microbiol, Bologna, Italy

[6] Univ Padua, Dipartimento Med Mol, Padua, Italy

[7] Univ Insubria, Clin Malattie Infett & Tropicali, Varese, Italy

[8] Ist Ortoped Rizzoli, Bologna, Italy

[9] ASST Giovanni XXIII, Bergamo, Italy

[10] ASST Niguarda, Grande Osped Metropolitano, Milan, Italy

[11] IRCCS Fdn Osped Maggiore Policlin, Milan, Italy

[12] Azienda Osped Univ, Padua, Italy

[13] IRCCS ISMETT, Palermo, Italy

[14] IRCCS Policlin San Matteo, Pavia, Italy

[15] IRCCS Ist Nazl Malattie Infett L Spallanzani, Rome, Italy

[16] Ist Super Sanita, Rome, Italy

[17] Policlin Umberto 1, Rome, Italy

[18] Azienda Osped Univ, Siena, Italy

[19] Azienda Osped Univ Citta Salute & Sci, Presidio Molinette, Turin, Italy

[20] Assessorato Polit Salute RER, Bologna, Italy

[21] Ctr Reg Trapianti Reg Emilia Romagna, Bologna, Italy

[22] Policlin St Orsola Malpighi, Bologna, Italy

[23] ASST Giovanni XXIII, Bergamo, Italy

[24] Ctr Reg Trapianti Reg Toscana, Florence, Italy

[25] Ctr Reg Trapianti, Milan, Italy

[26] ASST Niguarda, Grande Osped Metropolitano, Milan, Italy

[27] IRCCS Fdn Osped Maggiore Policlin, Milan, Italy

[28] Ctr Reg Trapianti Reg Veneto, Padua, Italy

[29] Azienda Osped Univ, Padua, Italy

[30] Ctr Reg Trapianti Reg Sicilia, Palermo, Italy

[31] IRCCS ISMETT, Palermo, Italy

[32] IRCCS Policlin San Matteo, Pavia, Italy

[33] Azienda Osped Univ, Siena, Italy

[34] Ctr Reg Trapianti Reg Lazio, Rome, Italy

[35] Ist Super Sanita, Ctr Nazl Trapianti, Rome, Italy

[36] Ctr Reg Trapianti, Turin, Italy

[37] Azienda Osped Univ Citta Salute & Sci Presidio Mo, Turin, Italy

来源：

CLINICAL MICROBIOLOGY AND INFECTION | 2019年 / 25卷 / 02期

关键词：

Colonization; CPE; Donor-recipient transmission; Infection; Solid organ transplant; KLEBSIELLA-PNEUMONIAE; BETA-LACTAMASES; KPC; EPIDEMIOLOGY; RESISTANCE; MORTALITY; EVOLUTION; SPREAD; ORGANS;

D O I：

10.1016/j.cmi.2018.05.003

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

Objectives: A prospective cohort study was conducted in Italy in order to describe the microbiologic aspects of colonization/infection by carbapenemase-producing Enterobacteriaceae (CPE) in donors and recipients of lung and liver transplants and the possible CPE transmission from donors to recipients. Methods: Between 15 January 2014 and 14 January 2015, all recipients of solid organ transplants (SOT) at ten lung and eight liver transplantation centres and the corresponding donors were enrolled. Screening cultures to detect CPE were performed in donors, and screening and clinical cultures in recipients with a 28-day microbiologic follow-up after receipt of SOT. Detection of carbapenemase genes by PCR, geno-typing by multilocus sequence typing, and pulsed-field gel electrophoresis and whole-genome sequencing were performed. Results: Of 588 screened donors, 3.4% were colonized with CPE. Of the liver first transplant recipients (n = 521), 2.5% were colonized before receipt of SOT and 5% acquired CPE during follow-up. CPE colonization was higher in lung first transplant recipients (n = 111, 2.7% before SOT and 14.4% after SOT). CPE infections occurred in 1.9% and 5.3% of liver or lung recipients, respectively. CPE isolates were mostly Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae belonging to CG258. Three events of donor-recipient CPE transmission, confirmed by whole-genome sequencing and/or pulsed-field gel electrophoresis, occurred in lung recipients: two involving K. pneumoniae sequence type 512 and one Verona integron-encoded metallo-beta-lactamase (VIM)-producing Enterobacter aerogenes. Conclusions: This study showed a low risk of donor-recipient CPE transmission, indicating that donor CPE colonization does not necessarily represent a contraindication for donation unless colonization regards the organ to be transplanted. Donor and recipient screening remains essential to prevent CPE transmission and cross-infection in transplantation centres. (C) 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

引用

页码：203 / 209

页数：7

共 7 条

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