Transmission of Multiresistant Bacteria from Donor to Recipient

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IntroductionInfections and colonizations with multi-drug-resistant bacteria (MDR) are rising around the world. Currently, an increasing number of patients admitted to intensive care units (ICUs) are exposed to infections with MDR organisms.Most of the organ donors come from ICUs, so they are susceptible to infections or colonization by MDR, that could potentially transmit to recipients.MDR are of particular concern because of their difficulty to treat which, in turn, results in significant morbidity and mortality, particularly among solid organ transplant recipients.Materials and MethodsWe registered all consecutive deceased organs donors in a critical care unit from a tertiary hospital with high donation activity and high incidence of MDR appearance.During 30 months we studied organ donors with MDR isolation and followed the organs of these donors as well as the MDR isolates in their corresponding recipients.Our protocol includes an active detection of any colonization by MDR through screening with swabs twice a week.The national critical care infection surveillance registry (ENVIN) has been in existence in our hospital since 1995 and includes data on selected nosocomial infections and colonizations in intensive care unit.The diagnosis of infection is made on the basis of set definitions, which depending on the type of infection include combinations of microbiological, radiological findings in combination with clinical signs of infection. For each case of nosocomial infection, further variables are documented, such as confirmed pathogens, date of infection, and temporal association of the infection with devices (tracheal tube, central venous catheter, urinary catheter).Results and DiscussionFrom 152 deceased organ donors (107 of them in encephalic death and 45 after expected cardiac arrest), in the study period, we detected 14 patients colonized or infected by MDR during our review. They were 67 years median age with an average icu stay of 9 days.From these 14 organ donors, we followed the 27 patients who received a graft from a donor with a positive culture for MDR. Four of them (15%) developed an MDR infection in the following year. Only in one case, the transmission from donor to recipient could be demonstrated. This donor was a patient with MDR bacteremia who was treated with an antibiotic for only 36 hours.ConclusionThe transmission of MDR from the donor to the recipient is a very rare occurrence. Close recipient follow-up is mandatory in order to validate this approach.The very limited available experience suggests that, in well-defined conditions, organs from donors who are MDR positive in surveillance studies (rectal axillary or pharyngous swabs), may be considered for transplantation. Nevertheless, when what is colonized or infected, is the environment of the organ to transplant, then avoidance of such donors appears advisable until further data are available.

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