Abstract
Although rare, donor-derived infections (DDIs) caused by multidrug-resistant (MDR) bacteria can have devastating consequences for organ transplant recipients. Recognition of MDR bacterial DDIs can be challenging, as MDR bacteria are prevalent in most hospitals and distinguishing their transmission through transplantation from other, more typical routes of acquisition are difficult. New technologies such as whole genome sequencing have recently proven to be a powerful advance in the investigation of MDR bacterial DDIs. Once recognized, the optimal treatment of MDR bacterial DDIs is not clear. Herein, we review the clinical manifestations, outcomes, and management of MDR bacterial DDIs, and identify areas of uncertainty toward which the transplant community should direct further research efforts.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance, •• Of major importance
Orlando G, Di Cocco P, Gravante G, D’Angelo M, Famulari A, Pisani F. Fatal hemorrhage in two renal graft recipients with multi-drug resistant Pseudomonas aeruginosa infection. Transpl Infect Dis. 2009;11:442–7.
Ison MG, Llata E, Conover CS, Friedewald JJ, Gerber SI, Grigoryan A, et al. Transmission of human immunodeficiency virus and hepatitis C virus from an organ donor to four transplant recipients. Am J Transplant. 2011;11:1218–25.
Fischer SA, Graham MB, Kuehnert MJ, Kotton CN, Srinivasan A, Marty FM, et al. Transmission of lymphocytic choriomeningitis virus by organ transplantation. N Engl J Med. 2006;354:2235–49.
Garzoni C, Ison MG. Uniform definitions for donor-derived infectious disease transmissions in solid organ transplantation. Transplantation. 2011;92:1297–300. Consensus definitions for donor-derived infections.
Vora NM, Basavaraju SV, Feldman KA, Paddock CD, Orciari L, Gitterman S, et al. Raccoon rabies virus variant transmission through solid organ transplantation. JAMA. 2013;310:398–407.
Rhee C, Eaton EF, Concepcion W, Blackburn BG. West Nile virus encephalitis acquired via liver transplantation and clinical response to intravenous immunoglobulin: case report and review of the literature. Transpl Infect Dis. 2011;13:312–7.
Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18:268–81. International consensus definitions of multidrug-resistance in bacteria.
Centers for Disease Control and Prevention (CDC). Transmission of multidrug-resistant Escherichia coli through kidney transplantation—California and Texas, 2009. MMWR Morb Mortal Wkly Rep. 2010;59:1642–6.
Watkins AC, Vedula GV, Horan J, Dellicarpini K, Pak SW, Daly T, et al. The deceased organ donor with an “open abdomen”: proceed with caution. Transpl Infect Dis. 2012;14:311–5.
Simkins J, Muggia V. Favorable outcome in a renal transplant recipient with donor-derived infection due to multidrug-resistant Pseudomonas aeruginosa. Transpl Infect Dis. 2012;14:292–5.
Martins N, Martins IS, de Freitas WV, de Matos JA, Magalhaes AC, Girao VB, et al. Severe infection in a lung transplant recipient caused by donor-transmitted carbapenem-resistant Acinetobacter baumannii. Transpl Infect Dis. 2012;14:316–20.
Goldberg E, Bishara J, Lev S, Singer P, Cohen J. Organ transplantation from a donor colonized with a multidrug-resistant organism: a case report. Transpl Infect Dis. 2012;14:296–9.
Ariza-Heredia EJ, Patel R, Blumberg EA, Walker RC, Lewis R, Evans J, et al. Outcomes of transplantation using organs from a donor infected with Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae. Transpl Infect Dis. 2012;14:229–36.
Giani T, Conte V, Mandala S, D’Andrea MM, Luzzaro F, Conaldi PG, et al. Cross-infection of solid organ transplant recipients by a multidrug-resistant Klebsiella pneumoniae isolate producing the OXA-48 carbapenemase, likely derived from a multiorgan donor. J Clin Microbiol. 2014;52:2702–5.
Mularoni A, Bertani A, Vizzini G, Gona F, Campanella M, Spada M, et al. Outcome of transplantation using organs from donors infected or colonized with carbapenem-resistant gram-negative bacteria. Am J Transplant. 2015;15:2674–82. The largest published series of multidrug-resistant donor-derived infections to date.
Coll P, Montserrat I, Ballester M, March F, Moya C, Obrador D, et al. Epidemiologic evidence of transmission of donor-related bacterial infection through a transplanted heart. J Heart Lung Transplant. 1997;16:464–7.
Johnston L, Chui L, Chang N, Macdonald S, McKenzie M, Kennedy W, et al. Cross-Canada spread of methicillin-resistant Staphylococcus aureus via transplant organs. Clin Infect Dis. 1999;29:819–23.
Altman DR, Sebra R, Hand J, Attie O, Deikus G, Carpini KW, et al. Transmission of methicillin-resistant Staphylococcus aureus via deceased donor liver transplantation confirmed by whole genome sequencing. Am J Transplant. 2014;14:2640–4. Application of whole genome sequencing to confirm transmission dynamics of DDI.
Wendt JM, Kaul D, Limbago BM, Ramesh M, Cohle S, Denison AM, et al. Transmission of methicillin-resistant Staphylococcus aureus infection through solid organ transplantation: confirmation via whole genome sequencing. Am J Transplant. 2014;14:2633–9. Application of whole genome sequencing to confirm transmission dynamics of DDI.
Miller R, Covington S, Taranto S, Carrico R, Ehsan A, Friedman B, et al. Communication gaps associated with donor-derived infections. Am J Transplant. 2015;15:259–64. An insightful analysis of the impact of communication gaps in the reporting and management of donor-derived infections on recipient outomes.
Ison MG, Grossi P. Donor-derived infections in solid organ transplantation. Am J Transplant. 2013;13 Suppl 4:22–30.
Nordmann P, Poirel L. The difficult-to-control spread of carbapenemase producers among Enterobacteriaceae worldwide. Clin Microbiol Infect. 2014;20:821–30.
Banerjee R, Johnson JR. A new clone sweeps clean: the enigmatic emergence of Escherichia coli sequence type 131. Antimicrob Agents Chemother. 2014;58:4997–5004.
Mathers AJ, Peirano G, Pitout JD. The role of epidemic resistance plasmids and international high-risk clones in the spread of multidrug-resistant Enterobacteriaceae. Clin Microbiol Rev. 2015;28:565–91.
Mathers AJ, Stoesser N, Sheppard AE, Pankhurst L, Giess A, Yeh AJ, et al. Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae at a single institution: insights into endemicity from whole-genome sequencing. Antimicrob Agents Chemother. 2015;59:1656–63.
Sifri CD, Ison MG. Highly resistant bacteria and donor-derived infections: treading in uncharted territory. Transpl Infect Dis. 2012;14:223–8.
Lumbreras C, Sanz F, Gonzalez A, Perez G, Ramos MJ, Aguado JM, et al. Clinical significance of donor-unrecognized bacteremia in the outcome of solid-organ transplant recipients. Clin Infect Dis. 2001;33:722–6.
Caliendo AM, Gilbert DN, Ginocchio CC, Hanson KE, May L, Quinn TC, et al. Better tests, better care: improved diagnostics for infectious diseases. Clin Infect Dis. 2013;57 Suppl 3:S139–70.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by the author.
Additional information
This article is part of the Topical Collection on Transplant and Oncology
Rights and permissions
About this article
Cite this article
Lewis, J.D., Sifri, C.D. Multidrug-Resistant Bacterial Donor-Derived Infections in Solid Organ Transplantation. Curr Infect Dis Rep 18, 18 (2016). https://doi.org/10.1007/s11908-016-0526-9
Published:
DOI: https://doi.org/10.1007/s11908-016-0526-9