Colonización intestinal por enterobacterias multirresistentes en pacientes con trasplante renal y hepático

Abstract

ABSTRACT: Background: Liver and kidney transplant recipients who are colonized by multi-drug resistant enterobacteria seem to have a greater risk of early infections. The aim of this study was to analyze the clinical and microbiological characteristics of infection episodes in colonized and non-colonized patients. Material and methods: Prospective cohort study which included patients who received liver or kidney transplants from October 2014 to December 2015. Rectal swab screening was performed in all patients prior to transplantation and every week after until day +30 post-transplantation. Microbiological data of the isolated strains was gathered and the colonized and non-colonized groups of patients were compared. Statistical analysis was performed using Mann-Whitney test, Fisher’s exact test and chisquare test for comparisons. A p-value < 0.05 was considered statistically significant. Results: Sixty-seven solid organ transplant recipients: 35 kidneys (52.2%), 25 liver (37.3%), 5 kidney-pancreas (7.5%) and 2 liver-kidney (3%) were included. Fifty-one were male, mean age 54.51 years old (SD: 11.208); mean of Charlson Comorbidity Index was 4.36 (SD: 1.881). Five patients (7.46%) were colonized before transplantation and 16 (23.88%) became colonized afterwards, being ESBL-E. coli the most frequent colonizing MDRE (44%). Infections by multi-drug resistant enterobacteria were observed in 1 (1.5%) colonized patient and in 1 (1.5%) non-colonized patient. Conclusions: Colonization by multidrug resistant enterobacteria prior to transplantation was low, although it increases after, being higher in kidney recipients. Infections in the first month post-transplantation caused by MDRE account for a low proportion of the total of infections. Surgery and hospitalization in the ICU during the year prior to transplantation and the need for ICU admission, hemodialysis and the use of urological catheters within the first month post-trasplantation were the risk factors associated with colonization by MDRE.