Impact of Multidrug-Resistant Bacteria Carriage in Pediatric Liver Transplant Recipients

Introduction: Bacterial infection is an important cause of morbidity and mortality in solid-organ transplantation. Moreover, due to the global spread of multidrug-resistant (MDR) bacteria, the management of those infections is even more challenging. Few data exist about the impact of MDR bacteria carriage on clinical outcome and empirical treatment in this specific population. The main goal of this study is to describe if MDR bacteria carriage has an influence or not on the incidence of bacterial infection during the 3 first months post-transplantation. Methods: The last 100 children who benefited from liver transplantation in our institution were included in this study (2012 to 2016). Screening for MDR bacteria including extended spectrum beta-lactamase (ESBL) and methicillin-resistant staphylococcus aureus (MRSA) carriage is systematically performed prior and after transplantation. We only considered documented infections by bacteriological cultures during the 3 first months post-transplant. Two groups of patients were compared, MDR bacteria carriers (n = 44) versus non-carrier (n = 55); no screening for 1 patient. Data included countries of origin and documented infections including those caused by MDR bacteria. Results: MDR bacteria carriage was significantly higher among patients originating from a country outside the European Union (EU) (including ex-Soviet Union countries, Algeria and Israel). Only 7 out of 31 (22.6%) patients were ESBL carriers in EU patients while 37 of 69 (53.6%) were ESBL carriers in the patients coming outside of EU (p < 0.01). MDR bacteria carriage was not associated with documented infection (36% in carriers vs 33% in non-carriers). Incidence of documented infections due to MDR bacteria was not increased in carriers versus non-carriers. Conclusion: Higher carriage of MDR bacteria was demonstrated in liver transplant pediatric recipients coming from outside EU compared to EU patients. The clinical implication of this carriage is unclear. Our preliminary results don’t show an increased incidence of post-transplant bacterial infections including MDR bacterial infections. However, MDR bacteria carriage may have important implications in terms of empirical antibiotherapy, including use of Colimycin, and infection control.