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Abstract
Discussion Forum (0)
Abstract number: 965

Session Type: ePosters

Session Title: ePosters

Authors(s): M.P. Freire (1), C.H. Camargo (2), A.Y. Yamada (2), F.O. Nagamori (2), J.O. Reusing Junior (3), F. Spadão (1), A.P. Cury (4), F. Rossi (4), W.C. Nahas (3), E. David-Neto (3), L.C. Pierrotti (5)

Authors Affiliations(s): (1) Working Committee for Hospital Epidemiology and Infection Control, University of São Paulo School of Medicine Hospital das Clínicas, Brazil, (2) Bacteriology Division, Instituto Adolfo Lutz, Brazil, (3) Renal Transplantation Unit, Department of Urology, University of São Paulo School of Medicine Hospital das Clínicas, Brazil, (4) Microbiology Laboratory, Department of Central Laboratory, University of São Paulo School of Medicine Hospital das Clínicas, Brazil, (5) Department of Infectious Diseases, University of São Paulo School of Medicine Hospital das Clínicas, Brazil

Background:

Carbapenem-resistant Pseudomonas aeruginosa (CRPA) infections are associated to a high mortality rate after kidney transplant (KT), however few studies described risk factors for CRPA infection among solid organ recipients.

Methods:

We identified an outbreak due to CRPA IMIP-producer in a KT ward through routine surveillance culture (SC) by real-time PCR for carbapenemase performed directly of rectal swab on february 2019. SC by real-time PCR was implanted for Carbapenem-resistant Entreobacteriaceae detection. Traditional SC for CRPA was started on March-2019. During the period of the outbreak, specific measures were taken to control CRPA transmission. On March 2020, the KT ward was closed due to COVID-19 pandemic and outbreak was resolved. A case-control study was performed. Controls were sorted among patients hospitalized at same ward during same period of the cases in a ratio of 3:1. Strains clonality was analyzed through PFGE, and whole genome sequency was performed for additional strain characterization. Multivariate risk factor  analysis, was performed by conditional logistic regression.

Results:

CRPA was identified in 37 patients, in 51.4% through surveillance cultures and in 49.6% through clinical cultures. The overall positivity rate for SC was 65.5%. considering only patients with positive clinical cultures, the positivity rate of traditional SC was 30.8%, and through real-time PCR 31.5%.The median time that patients maintained a positive culture was 42.5 days. 35.1% (15) of patients progressed with infection, the most common site was urinary tract (46.7%). 30-day mortality rate was 46.2%. PFGE analysis showed that all strain belonged to the same pulsotype. The MLST analysis identified the strain as ST446. Risk factors for CRPA acquisition were hospital stay >10 days, re-transplantation, urological surgical re-intervention after KT, use of carbapenem or ciprofloxacin within 3 months of CRPA episode and low median lymphocytes count in the past 3 months.

Conclusions:

KT recipients remain colonized by CRPA for a long period and could be a potential source for nosocomial outbreaks; further, a high proportion of these patients progress with infection. Real time PCR directly from rectal swab can be used as a supplementary tool on MDR surveillance.

Keyword(s): kidney transplant, surveillance culture, P. aeruginosa

Abstract number: 965

Session Type: ePosters

Session Title: ePosters

Authors(s): M.P. Freire (1), C.H. Camargo (2), A.Y. Yamada (2), F.O. Nagamori (2), J.O. Reusing Junior (3), F. Spadão (1), A.P. Cury (4), F. Rossi (4), W.C. Nahas (3), E. David-Neto (3), L.C. Pierrotti (5)

Authors Affiliations(s): (1) Working Committee for Hospital Epidemiology and Infection Control, University of São Paulo School of Medicine Hospital das Clínicas, Brazil, (2) Bacteriology Division, Instituto Adolfo Lutz, Brazil, (3) Renal Transplantation Unit, Department of Urology, University of São Paulo School of Medicine Hospital das Clínicas, Brazil, (4) Microbiology Laboratory, Department of Central Laboratory, University of São Paulo School of Medicine Hospital das Clínicas, Brazil, (5) Department of Infectious Diseases, University of São Paulo School of Medicine Hospital das Clínicas, Brazil

Background:

Carbapenem-resistant Pseudomonas aeruginosa (CRPA) infections are associated to a high mortality rate after kidney transplant (KT), however few studies described risk factors for CRPA infection among solid organ recipients.

Methods:

We identified an outbreak due to CRPA IMIP-producer in a KT ward through routine surveillance culture (SC) by real-time PCR for carbapenemase performed directly of rectal swab on february 2019. SC by real-time PCR was implanted for Carbapenem-resistant Entreobacteriaceae detection. Traditional SC for CRPA was started on March-2019. During the period of the outbreak, specific measures were taken to control CRPA transmission. On March 2020, the KT ward was closed due to COVID-19 pandemic and outbreak was resolved. A case-control study was performed. Controls were sorted among patients hospitalized at same ward during same period of the cases in a ratio of 3:1. Strains clonality was analyzed through PFGE, and whole genome sequency was performed for additional strain characterization. Multivariate risk factor  analysis, was performed by conditional logistic regression.

Results:

CRPA was identified in 37 patients, in 51.4% through surveillance cultures and in 49.6% through clinical cultures. The overall positivity rate for SC was 65.5%. considering only patients with positive clinical cultures, the positivity rate of traditional SC was 30.8%, and through real-time PCR 31.5%.The median time that patients maintained a positive culture was 42.5 days. 35.1% (15) of patients progressed with infection, the most common site was urinary tract (46.7%). 30-day mortality rate was 46.2%. PFGE analysis showed that all strain belonged to the same pulsotype. The MLST analysis identified the strain as ST446. Risk factors for CRPA acquisition were hospital stay >10 days, re-transplantation, urological surgical re-intervention after KT, use of carbapenem or ciprofloxacin within 3 months of CRPA episode and low median lymphocytes count in the past 3 months.

Conclusions:

KT recipients remain colonized by CRPA for a long period and could be a potential source for nosocomial outbreaks; further, a high proportion of these patients progress with infection. Real time PCR directly from rectal swab can be used as a supplementary tool on MDR surveillance.

Keyword(s): kidney transplant, surveillance culture, P. aeruginosa

Critical points and potential pitfalls in a persistent outbreak of carbapenem-resistant, IMP-1-producing Pseudomonas aeruginosa among kidney transplant recipients: a case-control study
Dra Maristela Freire
Dra Maristela Freire
Affiliations:
Universidade de São Paulo
ESCMID eAcademy. Freire M. 07/09/2021; 327891; 965
user
Dra Maristela Freire
Affiliations:
Universidade de São Paulo
Abstract
Discussion Forum (0)
Abstract number: 965

Session Type: ePosters

Session Title: ePosters

Authors(s): M.P. Freire (1), C.H. Camargo (2), A.Y. Yamada (2), F.O. Nagamori (2), J.O. Reusing Junior (3), F. Spadão (1), A.P. Cury (4), F. Rossi (4), W.C. Nahas (3), E. David-Neto (3), L.C. Pierrotti (5)

Authors Affiliations(s): (1) Working Committee for Hospital Epidemiology and Infection Control, University of São Paulo School of Medicine Hospital das Clínicas, Brazil, (2) Bacteriology Division, Instituto Adolfo Lutz, Brazil, (3) Renal Transplantation Unit, Department of Urology, University of São Paulo School of Medicine Hospital das Clínicas, Brazil, (4) Microbiology Laboratory, Department of Central Laboratory, University of São Paulo School of Medicine Hospital das Clínicas, Brazil, (5) Department of Infectious Diseases, University of São Paulo School of Medicine Hospital das Clínicas, Brazil

Background:

Carbapenem-resistant Pseudomonas aeruginosa (CRPA) infections are associated to a high mortality rate after kidney transplant (KT), however few studies described risk factors for CRPA infection among solid organ recipients.

Methods:

We identified an outbreak due to CRPA IMIP-producer in a KT ward through routine surveillance culture (SC) by real-time PCR for carbapenemase performed directly of rectal swab on february 2019. SC by real-time PCR was implanted for Carbapenem-resistant Entreobacteriaceae detection. Traditional SC for CRPA was started on March-2019. During the period of the outbreak, specific measures were taken to control CRPA transmission. On March 2020, the KT ward was closed due to COVID-19 pandemic and outbreak was resolved. A case-control study was performed. Controls were sorted among patients hospitalized at same ward during same period of the cases in a ratio of 3:1. Strains clonality was analyzed through PFGE, and whole genome sequency was performed for additional strain characterization. Multivariate risk factor  analysis, was performed by conditional logistic regression.

Results:

CRPA was identified in 37 patients, in 51.4% through surveillance cultures and in 49.6% through clinical cultures. The overall positivity rate for SC was 65.5%. considering only patients with positive clinical cultures, the positivity rate of traditional SC was 30.8%, and through real-time PCR 31.5%.The median time that patients maintained a positive culture was 42.5 days. 35.1% (15) of patients progressed with infection, the most common site was urinary tract (46.7%). 30-day mortality rate was 46.2%. PFGE analysis showed that all strain belonged to the same pulsotype. The MLST analysis identified the strain as ST446. Risk factors for CRPA acquisition were hospital stay >10 days, re-transplantation, urological surgical re-intervention after KT, use of carbapenem or ciprofloxacin within 3 months of CRPA episode and low median lymphocytes count in the past 3 months.

Conclusions:

KT recipients remain colonized by CRPA for a long period and could be a potential source for nosocomial outbreaks; further, a high proportion of these patients progress with infection. Real time PCR directly from rectal swab can be used as a supplementary tool on MDR surveillance.

Keyword(s): kidney transplant, surveillance culture, P. aeruginosa

Abstract number: 965

Session Type: ePosters

Session Title: ePosters

Authors(s): M.P. Freire (1), C.H. Camargo (2), A.Y. Yamada (2), F.O. Nagamori (2), J.O. Reusing Junior (3), F. Spadão (1), A.P. Cury (4), F. Rossi (4), W.C. Nahas (3), E. David-Neto (3), L.C. Pierrotti (5)

Authors Affiliations(s): (1) Working Committee for Hospital Epidemiology and Infection Control, University of São Paulo School of Medicine Hospital das Clínicas, Brazil, (2) Bacteriology Division, Instituto Adolfo Lutz, Brazil, (3) Renal Transplantation Unit, Department of Urology, University of São Paulo School of Medicine Hospital das Clínicas, Brazil, (4) Microbiology Laboratory, Department of Central Laboratory, University of São Paulo School of Medicine Hospital das Clínicas, Brazil, (5) Department of Infectious Diseases, University of São Paulo School of Medicine Hospital das Clínicas, Brazil

Background:

Carbapenem-resistant Pseudomonas aeruginosa (CRPA) infections are associated to a high mortality rate after kidney transplant (KT), however few studies described risk factors for CRPA infection among solid organ recipients.

Methods:

We identified an outbreak due to CRPA IMIP-producer in a KT ward through routine surveillance culture (SC) by real-time PCR for carbapenemase performed directly of rectal swab on february 2019. SC by real-time PCR was implanted for Carbapenem-resistant Entreobacteriaceae detection. Traditional SC for CRPA was started on March-2019. During the period of the outbreak, specific measures were taken to control CRPA transmission. On March 2020, the KT ward was closed due to COVID-19 pandemic and outbreak was resolved. A case-control study was performed. Controls were sorted among patients hospitalized at same ward during same period of the cases in a ratio of 3:1. Strains clonality was analyzed through PFGE, and whole genome sequency was performed for additional strain characterization. Multivariate risk factor  analysis, was performed by conditional logistic regression.

Results:

CRPA was identified in 37 patients, in 51.4% through surveillance cultures and in 49.6% through clinical cultures. The overall positivity rate for SC was 65.5%. considering only patients with positive clinical cultures, the positivity rate of traditional SC was 30.8%, and through real-time PCR 31.5%.The median time that patients maintained a positive culture was 42.5 days. 35.1% (15) of patients progressed with infection, the most common site was urinary tract (46.7%). 30-day mortality rate was 46.2%. PFGE analysis showed that all strain belonged to the same pulsotype. The MLST analysis identified the strain as ST446. Risk factors for CRPA acquisition were hospital stay >10 days, re-transplantation, urological surgical re-intervention after KT, use of carbapenem or ciprofloxacin within 3 months of CRPA episode and low median lymphocytes count in the past 3 months.

Conclusions:

KT recipients remain colonized by CRPA for a long period and could be a potential source for nosocomial outbreaks; further, a high proportion of these patients progress with infection. Real time PCR directly from rectal swab can be used as a supplementary tool on MDR surveillance.

Keyword(s): kidney transplant, surveillance culture, P. aeruginosa

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