Multidrug-resistant organism bloodstream infections in solid organ transplant recipients and impact on mortality: a systematic review

Abstract

AbstractBackgroundBloodstream infections (BSI) cause significant morbidity and mortality in solid organ transplant (SOT) recipients. There are few data regarding the contribution of multidrug-resistant organisms (MDROs) to these infections.ObjectivesWe evaluated the resistance-percentage of MDRO BSIs in SOT recipients and assessed associated mortality.MethodsA systematic reviewData sourcesMEDLINE and Embase databases up to January 2024.Study eligibility criteriaStudies of adult SOT recipients that quantify MDRO BSI resistance-percentage and/or associated crude mortality. MDROs studied were carbapenem-resistant Enterobacterales (CRE),Acinetobacter baumannii(CRAB) andPseudomonas aeruginosa(CRPA), third-generation-cephalosporin-resistant Enterobacterales (3GCR-E), methicillin-resistantStaphylococcus aureus(MRSA) and vancomycin-resistantEnterococcus faecium(VRE).ParticipantsAdult SOT recipients with a microbiologically confirmed BSI.InterventionsNot applicable.Risk of bias assessmentNewcastle Ottawa Scale.Methods of data synthesisMDRO BSI resistance-percentage and mortality outcomes were reported as median (IQR) and crude mortality (%), respectively.ResultsOf 945 studies identified, 52 were included. Most were retrospective (41/52) and/or single centre (37/52), and liver transplantation was the most studied SOT type (22/52). High resistance-percentages of BSIs were noted, ranging from 13.6% CRE for Enterobacterales to 59.2% CRAB forAcinetobacter baumannii. Resistance-percentage trends decreased over time, but these changes were not statistically significant. Asia had highest resistance-percentages for MRSA (86.2% [IQR 77.3-94.6%]), 3GCR-E (59.5% [IQR 40.5-66.7%]) and CRE (35.7% [IQR 8.3-63.1%]). North America had highest VRE resistance-percentages (77.7% [IQR 54.6-94.7%]). Crude mortality was 15.4-82.4% and was consistently higher than non-MDRO BSIs.ConclusionsMDRO BSIs resistance-percentages were high for all pathogens studied (IQR 24.6-69.4%) but there was geographical and temporal heterogeneity. MDRO BSIs were associated with high mortality in SOT recipients. Microbiological and clinical data in this vulnerable population were incomplete, highlighting the need for robust international multi-centre studies.