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Extended Spectrum -LactamaseProducing Enterobacteriaceae Infection in Heart and Lung Transplant Recipients and in Mechanical Circulatory Support Recipients

Bui, Kevin T.1; Mehta, Seema1; Khuu, Tam H.2; Ross, David3; Carlson, Margrit1; Leibowitz, Matthew R.1; Schaenman, Joanna M.1; Saggar, Rajan3; Lynch, Joseph P. III3; Ardehali, Abbas4; Kubak, Bernard M.1,5

Transplantation:
doi: 10.1097/01.TP.0000436928.15650.59
Clinical and Translational Research
Abstract

Background: Extended spectrum β-lactamase (ESBL)–producing gram-negative bacilli are increasingly reported in patients with a variety of risk factors including prior cephalosporin and antibiotic usage, prolonged hospitalizations, existence of comorbid conditions, and critical illness.

Methods: Retrospective review of infections caused by ESBL-producing Enterobacteriaceae was performed in heart transplant (HTx), lung transplant (LTx), and mechanical circulatory support (MCS) device recipients at a large transplant center.

Results: Among 1065 patients transplanted/implanted, the incidence of ESBL-related infections (bacteremia, urinary tract infections, pneumonia, central venous catheter–associated infection, and wound infections) in HTx, LTx, and MCS device recipients was reported at 2.2%, 5.5%, and 10.7%, respectively, caused by ESBL-producing Klebsiella pneumoniae, Escherichia coli, Klebsiella oxytoca, and Citrobacter freundii.

Conclusions: Early detection and adequate duration of therapy for ESBL-producing Enterobacteriaceae in solid organ transplants and MCS device recipients are essential in successful patient outcomes including prevention of recurrent infection.

Author Information

1 Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA. Ronald Reagan UCLA Medical Center, Los Angeles, CA.

2 Heart/Lung Transplant. Ronald Reagan UCLA Medical Center, Los Angeles, CA.

3 Division of Pulmonary & Critical Care, Department of Medicine, David Geffen School of Medicine at UCLA. Ronald Reagan UCLA Medical Center, Los Angeles, CA.

4 Dvision of Cardiothoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA. Ronald Reagan UCLA Medical Center, Los Angeles, CA.

5 Address correspondence to: Bernard M. Kubak, Ph.D., M.D., David Geffen School of Medicine at UCLA, Transplant Infectious Diseases, Heart/Lung Transplant, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 7501A, Los Angeles, CA 90095.

Research of B.M.K. was partially supported by a research grant from the Investigator-Initiated Studies Program of Merck & Co., Inc. The opinions expressed in this paper are those of the authors and do not necessarily represent those of Merck & Co., Inc.

All the other authors declare no funding or conflicts of interest.

E-mail: bkubak@mednet.ucla.edu

K.T.B., M.C., M.R.L., and B.M.K. participated in research design, data collection, data analysis, and writing of the article. S.M. and T.H.K. participated in data collection, data analysis, and writing of the article. D.R. and R.S. participated in clinical management of patients, data collection, and writing of the article. J.M.S. participated in data collection, and writing of the article. J.P.L. and A.A. participated in clinical management of patients and data collection.

Received 22 July 2013. Revision requested 8 August 2013.

Accepted 9 September 2013.

Accepted October 25, 2013

© 2014 by Lippincott Williams & Wilkins