Molecular characterization of multidrug resistant Enterobacterales strains isolated from liver and kidney transplant recipients in Spain

• Published in: Scientific reports 2021-06, Vol.11 (1), p.11875-11875, Article 11875
• Main Authors: Fernández-Martínez, Marta, González-Rico, Claudia, Gozalo-Margüello, Mónica, Marco, Francesc, Gracia-Ahufinger, Irene, Aranzamendi, Maitane, Sánchez-Díaz, Ana M., Vicente-Rangel, Teresa, Chaves, Fernando, Calvo Montes, Jorge, Martínez-Martínez, Luis, Fariñas, Maria Carmen
• Format: Article
• Language: English
• Subjects: 631/326; 631/326/107; 631/326/22; Carbapenems; Colonization; E coli; Enterobacterales; Humanities and Social Sciences; Infections; Kidney transplantation; Kidney transplants; Klebsiella pneumoniae; Liver transplantation; multidisciplinary; Multidrug resistance; Multidrug resistant organisms; Pancreas transplantation; Patients; Science; Science (multidisciplinary); Strains (organisms); Transplants & implants; β Lactamase; β-Lactam antibiotics
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-021-90382-5

The objective of this study was to analyse the mechanisms of resistance to carbapenems and other extended-spectrum-β-lactams and to determine the genetic relatedness of multidrug-resistant Enterobacterales (MDR-E) causing colonization or infection in solid-organ transplantation (SOT) recipients. Prospective cohort study in kidney (n = 142), liver (n = 98) or kidney/pancreas (n = 7) transplant recipients between 2014 and 2018 in seven Spanish hospitals. We included 531 MDR-E isolates from rectal swabs obtained before transplantation and weekly for 4–6 weeks after the procedure and 10 MDR-E from clinical samples related to an infection. Overall, 46.2% Escherichia coli , 35.3% Klebsiella pneumoniae , 6.5% Enterobacter cloacae , 6.3% Citrobacter freundii and 5.7% other species were isolated. The number of patients with MDR-E colonization post-transplantation (176; 71.3%) was 2.5-fold the number of patients colonized pre-transplantation (71; 28.7%). Extended-spectrum β-lactamases (ESBLs) and carbapenemases were detected in 78.0% and 21.1% of MDR-E isolates respectively. In nine of the 247 (3.6%) transplant patients, the microorganism causing an infection was the same strain previously cultured from surveillance rectal swabs. In our study we have observed a low rate of MDR-E infection in colonized patients 4–6 weeks post-transplantation. E. coli producing bla CTX-M-G1 and K. pneumoniae harbouring bla OXA-48 alone or with bla CTX-M-G1 were the most prevalent MDR-E colonization strains in SOT recipients.