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PLoS One. 2015 Apr 2;10(4):e0123706. doi: 10.1371/journal.pone.0123706. eCollection 2015.

Incidence of carbapenem-resistant gram negatives in Italian transplant recipients: a nationwide surveillance study.

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Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy.
Italian National Transplant Center, Italian National Institute of Health (ISS), Rome, Italy.
Division of Infectious Diseases, Department of Surgical and Morphological Sciences, University of Insubria-Ospedale di Circolo, Varese, Italy.
Direzione Generale Salute Lombardia, Regione Lombardia, Milan, Italy.
Divisions of Infectious Diseases & Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America.
Division of Epidemiology and the Laboratory for Molecular Epidemiology and Antibiotic Research, Sourasky Medical Center, Tel Aviv, Israel.



Bacterial infections remain a challenge to solid organ transplantation. Due to the alarming spread of carbapenem-resistant gram negative bacteria, these organisms have been frequently recognized as cause of severe infections in solid organ transplant recipients.


Between 15 May and 30 September 2012 we enrolled 887 solid organ transplant recipients in Italy with the aim to describe the epidemiology of gram negative bacteria spreading, to explore potential risk factors and to assess the effect of early isolation of gram negative bacteria on recipients' mortality during the first 90 days after transplantation. During the study period 185 clinical isolates of gram negative bacteria were reported, for an incidence of 2.39 per 1000 recipient-days. Positive cultures for gram negative bacteria occurred early after transplantation (median time 26 days; incidence rate 4.33, 1.67 and 1.14 per 1,000 recipient-days in the first, second and third month after SOT, respectively). Forty-nine of these clinical isolates were due to carbapenem-resistant gram negative bacteria (26.5%; incidence 0.63 per 1000 recipient-days). Carbapenems resistance was particularly frequent among Klebsiella spp. isolates (49.1%). Recipients with longer hospital stay and those who received either heart or lung graft were at the highest risk of testing positive for any gram negative bacteria. Moreover recipients with longer hospital stay, lung recipients and those admitted to hospital for more than 48h before transplantation had the highest probability to have culture(s) positive for carbapenem-resistant gram negative bacteria. Forty-four organ recipients died (0.57 per 1000 recipient-days) during the study period. Recipients with at least one positive culture for carbapenem-resistant gram negative bacteria had a 10.23-fold higher mortality rate than those who did not.


The isolation of gram-negative bacteria is most frequent among recipient with hospital stays >48 hours prior to transplant and in those receiving either heart or lung transplants. Carbapenem-resistant gram negative isolates are associated with significant mortality.

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