1573. Antipseudomonal Drug Exposure Associated with MDR Organisms in the Liver and Lung Transplant Population
Session: Poster Abstract Session: Stewardship: Improving Outcomes
Friday, October 6, 2017
Room: Poster Hall CD
  • MulugetaS_IDWeek2017.pdf (250.1 kB)
  • Background: Multi-drug resistant (MDR) Gram-negative bacteria (GNB) are an emerging complication in transplant recipients. This study describes the prevalence of and risk factors for MDR-GNB infection/colonization in the liver and lung transplant population.

    Methods: Cross-sectional study with nested case-case-control included adult liver or lung transplant candidates/recipients from 1/10-7/16. Patients with a positive GNB culture were classified as MDR- or Susceptible (S)-cases; MDR was defined as in vitro resistance to ≥ 3 antibiotic classes. Patients without a positive GNB culture were controls. Primary variable of interest: antibiotic days of therapy (DOT) during time at risk. Patient and isolate characteristics were collected and compared.

    Results: We included 150 patients: 110 (73%) liver, 40 (27%) lung. Median (IQR) patient age and Charlson comorbidity index were 59 years (52-63) and 5 points (3-6). Isolated organisms: 31 (34%) E. coli, 28 (31%) K. pneumoniae, 33 (36%) others. Resistance to cefepime, piperacillin/tazobactam, and ertapenem: 38%, 27%, and 14%. 61 (41%) MDR-GNB, 21 (14%) S-GNB, 68 (45%) controls. Median (IQR) cumulative antibiotic DOT was: MDR-case – 24.5 days (6-46.5), S-case – 5 days (2-24, p=0.017 vs MDR), controls – 0 days (0-10, p<0.001 vs MDR). Median (IQR) antipseudomonal (AP) DOT was: MDR-case – 7 days (1-16), S-case – 1 day (0-8, p=0.055 vs MDR), controls – 0 days (0-1, p<0.001 vs MDR); AP exposure was independently associated with MDR-GNB infection/colonization after correcting for severity of disease pre-transplant (adjOR: 2.9, 95% CI: 1.6-5.3) (Table 1).

    Conclusion: MDR-GNB represent a significant burden to the liver and lung transplant population. A detailed antibiotic history, including AP DOT, may help with risk assessment to guide empiric therapy selection.

    Table 1. Variables associated with MDR-GNB infection/colonization during time at risk (AdjOR, 95% CI)

    MDR-cases vs S-cases,


    MDR-cases vs controls,


    MDR-cases vs combined comparator, (n=150)

    High MELD (> 30) or LAS (>50)

    1.1 (0.6-1.9)

    1.3 (0.7-2.3)

    1.5 (0.8-2.6)

    AP drug exposure

    1.1 (0.6-2.0)

    3.5 (1.9-6.3)

    2.9 (1.6-5.3)

    Prior hospitalization

    0.9 (0.7-1.0)

    Surafel G Mulugeta, PharmD, MS1, Michael P Veve, PharmD1,2, Arin S Jantz, PharmD1, Odaliz Abreu Lanfranco, MD1 and Susan L Davis, PharmD1,3, (1)Henry Ford Hospital, Detroit, MI, (2)Wayne State University College of Pharmacy, Detroit, MI, (3)Pharmacy Practice, Wayne State University, Detroit, MI


    S. G. Mulugeta, None

    M. P. Veve, None

    A. S. Jantz, None

    O. Abreu Lanfranco, None

    S. L. Davis, Allergan: Grant Investigator and Scientific Advisor , Consulting fee and Research grant
    Merck: Grant Investigator and Scientific Advisor , Consulting fee and Research grant

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.