The Impact of Colonization by Multi Drug Resistant Bacteria on Graft Survival, Risk of Infection, and Mortality in Recipients of Solid Organ Transplant: Systematic Review and Meta-analysis.

BACKGROUND

The Global increase in colonization by multidrug-resistant (MDR) bacteria poses a significant concern. The precise impact of MDR colonization in solid organ transplant recipients (SOTR) remains not well established.

OBJECTIVES

Assess the impact of MDR colonization on SOTR's mortality, infection, or graft-loss.

METHODS

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DATA SOURCE

Data from PROSPERO, OVID Medline, Ovid EMBASE, Wiley Cochrane Library, ProQuest Dissertations, Theses Global, and SCOPUS, were systematically reviewed spanning from inception until March 20, 2023. The study protocol was registered with PROSPERO (CRD42022290011) and followed the PRISMA guidelines. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, INTERVENTIONS, AND ASSESSMENT OF RISK OF BIAS: Cohorts and case-control studies that reported on adult SOTR colonized by Methicillin-resistant Staphylococcus-aureus (MRSA), Vancomycin-resistant Enterococci (VRE), Extended-spectrum beta-lactamase (ESBL) or carbapenem-resistant Enterobacteriaceae (CRE), or MDR-Pseudomonas, and compared to non-colonized, were included. Two reviewers assessed eligibility, conducted risk of bias evaluation using the Newcastle-Ottawa scale, and rated certainty of evidence using the GRADE approach.

METHODS OF DATA SYNTHESIS

We employed RevMan for a meta-analysis using random-effects models to compute pooled odds-ratios (OR) and 95% confidence-intervals (CI). Statistical heterogeneity was determined using the I

RESULTS

15,202 SOTR (33 cohort, 6 case-control studies) were included, where Liver transplant and VRE colonization (25 and 14 studies) were predominant. MDR colonization significantly increased post-transplant one-year mortality (OR= 2.35, 95%CI 1.63-3.38) and mixed-infections (OR=10.74, 95%CI 7.56-12.26) across transplant types (p<0.001 and I

CONCLUSIONS

MDR colonization in SOTR, particularly CRE, is associated with increased mortality. Despite the low certainty of evidence, actions for preventing MDR colonization in transplant candidates are warranted.

Informations de copyright

Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Conflict of Interests The authors of this manuscript have no conflicts of interest to disclose.