Surveillance culture for multidrug-resistant gram-negative bacteria: Performance in liver transplant recipients

Publication date: 1 March 2017
Source:American Journal of Infection Control, Volume 45, Issue 3
Author(s): Maristela Pinheiro Freire, Isabel Cristina Villela Soares Oshiro, Patrícia Rodrigues Bonazzi, Ligia Câmera Pierrotti, Larissa Marques de Oliveira, Anna Silva Machado, Inneke Marie Van Der Heijdenn, Flavia Rossi, Silvia Figueiredo Costa, Luiz Augusto Carneiro D'Albuquerque, Edson Abdala
BackgroundThe prevalence of infection with multidrug-resistant gram-negative bacteria (MDR-GNB) after solid-organ transplantation is increasing. Surveillance culture (SC) seems to be an important tool for MDR-GNB control. The goal of this study was to analyze the performance of SC for MDR-GNB among liver transplant (LT) recipients.MethodsThis was a prospective cohort study involving patients who underwent LT between November 2009 and November 2011. We screened patients for extended spectrum β-lactamase-producing Escherichia coli, extended spectrum β-lactamase-producing Klebsiella pneumoniae, and carbapenem-resistant Enterobacteriaceae, carbapenem-resistant Pseudomonas aeruginosa (CRPA), and carbapenem-resistant Acinetobacter baumannii (CRAB). We collected SC samples immediately before LT and weekly thereafter, until hospital discharge. Samples were collected from the inguinal-rectal area, axilla, and throat. The performance of SC was evaluated through analysis of its sensitivity, negative predictive value, and accuracy.ResultsDuring the study period, 181 patients were evaluated and 4,110 SC samples were collected. The GNB most often identified was CRAB, in 45.9% of patients, followed by CRKP in 40.3%. For all microorganisms, the positivity rate was highest among the inguinal-rectal samples. If only samples collected from this area were considered, the SC would fail to identify 34.9% of the cases of CRAB colonization. The sensitivity of SC for CRKP was 92.5%. The performance of SC was poorest for CRAB (sensitivity, 80.6%).ConclusionsOur data indicate that SC is a sensitive tool to identify LT recipients colonized by MDR-GNB.



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