Real-time, random-access organ screening for carbapenem-resistant organisms (CRO) reduces CRO-associated, donor-derived infection mortality in lung transplant recipients

Author:

Zhou Wen-Yong,Shen Lei,Shi Jian-Xin,Gao Xing-Hui,Yang Jun,Fu Shi-Jie,Pan Xu-Feng,Zhu Min-Fang,Zhang Shen,Zhang Chong,Li Feng,Zhang Hai,Yao Feng,Tenover Fred C.,Tang Yi-Wei,Fang Wen-Tao

Abstract

Abstract Purpose Donor-derived infection (DDI) has become an important factor affecting the prognosis of lung transplantation patients. The risks versus benefits of using donor organs infected with multidrug-resistant organisms (MDRO), especially carbapenem-resistant organisms (CRO), are frequently debated. Traditional microbial culture and antimicrobial susceptibility testing at present fail to meet the needs of quick CRO determination for donor lungs before acquisition. In this study, we explored a novel screening method by using Xpert® Carba-R assay for CRO in donor lungs in a real-time manner to reduce CRO-associated DDI mortality. Methods This study was registered on chictr.org.cn (ChiCTR2100053687) on November 2021. In the Xpert Carba-R screening group, donor lungs were screened for CRO infection by the Xpert Carba-R test on bronchoalveolar fluid (BALF) before acquisition. If the result was negative, donor lung acquisition and subsequent lung transplantation were performed. In the thirty-five potential donors, nine (25.71%) with positive Xpert Carba-R results in BALF were declined for lung transplantation. Twenty-six recipients and the matching CRO-negative donor lungs (74.29%) were included in the Xpert Carba-R screening group. In the control group, nineteen recipients underwent lung transplants without Xpert Carba-R screening. The incidence and mortality of CRO-associated DDI were collected and contrasted between the two groups. Results Multivariate analysis showed that CRO-related death due to DDI within 60 days was significantly lower in the Xpert Carba-R screening group than that in the control group (OR = 0.05, 95% CI 0.003–0.74, p = 0.03). Conclusion Real-time CRO screening of donor lungs before transplantation at the point of care by the Xpert Carba-R helps clinicians formulate lung transplantation strategies quickly and reduces the risk of subsequent CRO infection improving the prognosis of lung transplantation.

Funder

National Natural Science Foundation of China

Basic Research Foundation of Shanghai Chest Hospital

Foundation of the Center for Medical and Engineering Interdisciplinary Innovation, University of Shanghai for Science and Technology

Clinical Research Projects in Health industry of Shanghai Municipal Health Commission

Cepheid Investigator-Initiated Study award

Interdisciplinary Program of Shanghai Jiao Tong University

Publisher

Springer Science and Business Media LLC

Subject

Infectious Diseases,Microbiology (medical),General Medicine

Reference19 articles.

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