A prediction model may enable better targeting of early interventions for carbapenem resistance Intestinal Infection (CRE) after liver transplantation (LT) among carriers, according to study results published in Clinical Infectious Diseases.
In this multinational retrospective study, the researchers aimed to develop a prediction model for bacterial infection within 30 and 60 days after LT when the probability of infection with crystalloids exceeded 10%. Data were collected from 840 patients from 15 hospitals (most of them infected with CRE endemic with Klebsiella pneumoniae carbapenemase as the main mechanism of CRE), with follow-up occurring 180 days after LT.
In 840 patients (65.4% men; median age 55 years), the primary indicator of LT was viral hepatitis (44.8%) followed by alcoholic hepatitis (24.6%). A total of 250 patients had CRE infection after LT There were 203 patients who were carriers of CRE before LT, and 637 patients were colonized with CRE after LT.
Although pre-transplant CRE carriers had more severe liver disease and a complex clinical course compared with pre-transplant LT carriers, the incidence of CRE was similar between the two groups (33% and 28.7%, respectively), and there was no difference. In all-cause mortality at 180 days (56.7% vs 58.5%, s = .46). However, time to infection after LT was earlier for LT CRE carriers (median, 9 vs 23 days).
To assess risk factors for multicellular infection, the researchers performed a multivariate analysis that included the following six variables: surgical re-intervention, prolonged mechanical ventilation, acute kidney injury, CRE creatinine colonization before 60 days of transplantation, creatinine colonization within 60 days after transplantation, and colonization Multisite. Within 60 days after transplantation. The expected risk of drug infection within 30 and 60 days after LT was 15% (interquartile range [IQR], 11%-24%) and 21% (IQ, 15%-33%), respectively.
The model showed acceptable 60-day discrimination and predictive accuracy for CRE infection when evaluated against the AUC derivation. [area under the curve] 74.6 (95% CI, 70.9-78.4), Brier Index 16.3 (95% CI, 6.7-25.9) and bootstrap verification data set AUC 73.9 (95% CI, 67.7-79.1), Brier Index 16.6 (95% CI, 14.6- 19.1) ”, noted the researchers.
The findings from this study highlight that the default strategy for treating all CRE carriers may be inferior to the targeted strategy, given that the probability of CRE is higher than 10%. The researchers concluded, “Further studies are needed to further validate the model and determine which strategy would be most effective, in terms of adverse events and collateral resistance effect, and ultimately patient survival after transplantation.”
Giannella M, Freire M, Rinaldi M, et al. Development of a risk prediction model for carbapenem resistance Intestinal Infection after liver transplantation: a multinational cohort study. clen infect dis. Published online February 10, 2021. doi: 10.1093/cid/ciab109