An Emerging Issue: Carbapenem-Resistant Enterobacteriaceae in Solid-Organ Transplantation

Objectives: Bloodstream infections caused by carbapenem-resistant bacteria have increased globally. Solid-organ transplant recipients are more prone to these infections. This study aimed to compare the clinical courses of carbapenem-susceptible and carbapenem-resistant Enterobacteriaceae bloodstream infections and to identify risk factors for carbapenem resistance in solid- organ transplant recipients. Materials and Methods: For this retrospective descriptive study, data for solid-organ transplant recipients (age =18) treated from 2015 to 2022 were obtained from medical records. Enterobacteriaceaepositive blood culture was screened from laboratory data. Results: Among 72 patients, there were 100 bacteremia episodes. Patients included 40 kidney (55.6%), 21 liver (29.2%), 7 heart (9.7%), and 4 combined liver and kidney (5.6%) transplant recipients. Fifty-seven bacteremia episodes were recorded between 2015 and 2020, and 43 bacteremia episodes were recorded between 2020 and 2022. Carbapenem resistance was reported in 15.8% of patients before 2020, whereas this rate increased to 39.5% after 2020 (P =.007). Pitt bacteremia score =4 (P <.001), Charlson comorbidity index =4 (P =.021), chronic liver disease (P =.015), septic shock at admission (P =.001), hypotension at admission (P =.006), bacteremia episodes 48 hours after hospitalization (P =.004), hospitalization in the past 3 months (P =.004), and prior invasive procedure (P =.043) were significant factors for carbapenem resistance. Logistic regression analysis showed that bacteremia 48 hours after hospitalization (P =.002) and hospitalization in the past 3 months (P =.006) were independent risk factors. Conclusions: Carbapenem resistance increased significantly over the years. Bacteremia 48 hours after hospitalization and hospitalization within the past 3 months were determined to be risk factors for carbapenem resistance. Carbapenem-resistant infections are still nosocomial infections. Patients should be hospitalized for as a short time as possible, and both patients and their physicians should follow infection control and prevention methods.