Pretransplant Fecal Carriage of Extended-Spectrum β-Lactamase–producingEnterobacteriaceaeand Infection after Liver Transplant, France

作者：Frédéric Bert, Béatrice Larroque, Cathérine Paugam‐Burtz, Fédérica Dondero, François Durand, Estelle Marcon, Jacques Belghiti, Richard Moreau, Marie-Hélène Nicolas-Chanoine · 发表于：Emerging infectious diseases · 年份：2012 · DOI：10.3201/eid1806.110139 · 被引用次数：115 · 研究领域：Antibiotic Resistance in Bacteria、Antibiotics Pharmacokinetics and Efficacy、Pneumocystis jirovecii pneumonia detection and treatment

Extended-spectrum β-lactamase-producing Enterobacteriaceae isolates (ESBLE) are emerging pathogens that confer resistance to antimicrobial drugs. We conducted a 10-year study in France (January 2001-April 2010) to investigate the incidence of and risk factors for ESBLE infections after liver transplant. Of 710 transplant patients screened preoperatively for ESBLE fecal carriage, 5.5% had ESBLE infection develop within 4 months after surgery; patients with pretransplant ESBLE fecal carriage were more likely to have infection develop than were noncarriers. Typing showed extensive genetic diversity, with a large predominance of CTX-M enzymes. Independent predictors of ESBLE infection were pretransplant fecal carriage, Model for End Stage Liver Disease score >25, and return to surgery. Our results indicate that the influx of preoperatively acquired ESBLE isolates into the hospital outweighs cross-transmission in the epidemiology of ESBLE infections after liver transplant. Transplant candidates should be systematically screened for carriage, and posttransplant infection in carriers should be treated with carbapenems.