Organ donor screening for carbapenem‐resistant gram‐negative bacteria in Italian intensive care units: the DRIn study. Issue 1 (18th September 2019)

• Record Type: Journal Article
• Authors: Procaccio, Francesco; Masiero, Lucia; Vespasiano, Francesca; Grossi, Paolo A.; Gagliotti, Carlo; Pantosti, Annalisa; Caprio, Mario; Lombardini, Letizia; Nanni Costa, Alessandro
• Other Names: Maccarone Daniela investigator.; Giacon Bruno investigator.; Saracino Angelo investigator.; Mancini Pellegrino investigator.; Giannattasio Paolo investigator.; Sangiorgi Gabriela investigator.; Licari Maurizia investigator.; Valeri Maurizio investigator.; Munoz Lopez Montserrat investigator.; Moschini Massimo investigator.; Giacometti Raffaella investigator.; Panebianco Annarita investigator.; Littera Roberto investigator.; Butera Angelita investigator.; Bonizzoli Manuela investigator.; Pilati Laura investigator.; Dovas Atanassios investigator.; Lazzarini Fabio investigator.; Coluccio Elena investigator.; Vesconi Sergio investigator.; Ghirardini Angelo investigator.; Puoti Francesca investigator.; Ricci Andrea investigator.; Di Ciaccio Paola investigator.
• Is Part Of: American journal of transplantation. Volume 20:Issue 1(2020)
• Page Start: 262
• Page End: 273
• Publication Date: 2019-09-18
• Subjects: clinical research/practice -- donors and donation: donation after brain death (DBD) -- donors and donation: donor evaluation -- infection and infectious agents ‐ bacterial -- organ procurement and allocation -- risk assessment/risk stratification; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.15566
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : The 759 cases of brain death declaration (BDD [Italian law, 6 hours of observation time]) that occurred in 190 Italian intensive care units (ICUs) between May and September 2012 were studied to quantify carbapenem‐resistant gram‐negative bacteria (CR‐GN) isolated in organ donors, to evaluate adherence to national screening guidelines, and to identify risk factors for CR‐GN isolation. Mandatory blood, bronchoalveolar lavage, and urine cultures were performed on the BDD day in 99% of used donors. Because results were rarely made available before transplant, >20% of transplants were performed before obtaining any microbiological information, and organs from 15 of 22 CR‐GN cases were used. Two (lung–liver) of the 37 recipients died, likely because of donor‐derived early CR‐GN sepsis. ICU stay >3 days (odds ratio [OR] = 7.49, P = .004), fever (OR = 3.11, P = .04), age <60 years (OR = 2.80, P = .06), and positive ICU epidemiology (OR = 8.77, P = .07) were associated with CR‐GN isolation. An association between single ICU and risk of CR‐GN was observed, as a result of differences across ICUs (ICC = 29%; 95% confidence interval [CI] 6.5%‐72%) probably related to inadequate practices of infection control. Continuous education aimed at implementing priority actions, including stewardship programs for a rational use of antimicrobials, is a priority in healthcare systems and transplant networks. Improved awareness among ICU personnel regarding the importance of early CR‐GN detection and timely alert systems might facilitate decisions regarding organ suitability and eventually save recipient lives. Abstract : In this national study, the authors evaluate the risk factors for carbapenem‐resistant, gram‐negative bacteria isolation in brain dead organ donors and possibly related recipient deaths, suggesting that tailored surveillance cultures, timely information, and alert systems based on critical care personnel education and transplant network organization might facilitate and improve decisions regarding organ suitability.