The impact of carbapenemase producing Enterobacteriaceae colonization on infection risk after liver transplantation: a prospective observational cohort study

Abstract Objective To investigate the impact of colonization with carbapenemase producing Enterobacteriaceae (CPE) on the CPE infection risk after liver transplantation (LT). Methods Prospective cohort study of all adult patients undergoing LT at our center over 8-year period (2010-2017). Patients were screened for CPE colonization by rectal swabs at inclusion on waiting list, immediately before LT, and weekly after LT until hospital discharge. Asymptomatic carriers did not receive decolonization, anti-CPE prophylaxis or preemptive antibiotic therapy. Patients were followed-up to 1 year after LT. Results We analyzed 553 patients who underwent first LT, 38 were colonized with CPE at LT and 104 acquired colonization after LT. CPE colonization rates at LT and acquired after LT increased significantly over study period: IRR 1.21 (95%CI 1.05-1.39) and 1.17 (1.07-1.27), respectively. Overall, 57 patients developed CPE infection within a median of 31 (IQR 11-115) days after LT, with an incidence of 3.05 cases per 10,000 LT-recipient-days and a non-significant increase over the study period (IRR 1.11, 0.98-1.26). In multivariable analysis, CPE colonization at LT (HR 18.50, 6.76-50.54) and acquired after LT (HR 16.89, 6.95-41.00) were strongest risk factors for CPE infection, along with combined transplant (HR 2.60, 1.20-5.59), higher MELD at the time of LT (HR 1.03, 1.00-1.07), prolonged mechanical ventilation (HR 2.63, 1.48-4.67), re-intervention (HR 2.16, 1.21-3.84) and rejection (HR 2.81, 1.52-5.21). Conclusions CPE colonization at LT or colonization acquired after LT were the strongest predictors of CPE infection. Prevention strategies focused on LT candidates and recipients colonized with CPE should be investigated.