MDRO Working Group

Chair: Stephanie M. Pouch, MD, MS

Co-Chair: Anoma Nelore, MD

Working Group Statement: The Infectious Disease Community of Practice's Multidrug-Resistant Organisms (MDRO) Working Group provides a forum to address the evolving global burden of multidrug-resistant pathogens in solid organ transplant candidates and recipients.  We foster development and implementation of international, multicenter studies to address the epidemiology and outcomes of transplant recipients with such infections in order to improve patient care, inform practice decisions, identify new knowledge gaps, and contribute to discussions surrounding antimicrobial stewardship.

Current Projects

• Impact of MDR Pseudomonas in Lung recipients with cystic fibrosis

  • Principal Investigators: Stephanie Pouch, David van Duin

  • Description: Respiratory tract colonization with Pseudomonas aeruginosa is common in lung transplant recipients and has been implicated in the development of bronchiolitis obliterans syndrome (BOS) following transplantation. The prevalence of multidrug-resistant (MDR) and pan-resistant (PR) Pseudomonas aeruginosa is highest among cystic fibrosis (CF) lung transplant recipients, and the long-term impact of MDR or PR Pseudomonas aeruginosa colonization has not been well-established in this patient population.  While several studies suggest that CF patients with MDR or PR pseudomonal colonization prior to transplant have similar rates of survival compared to individuals with CF harboring more sensitive isolates, these studies have been small and did not address other post-transplant complications, including the development of BOS.  This study aims to 1) describe the outcomes of CF-lung transplant recipients colonized with Pseudomonas aeruginosa prior to transplantation and 2) evaluate the impact of prophylactic antimicrobials and the duration of antibiotic prophylaxis on clinical and microbiologic outcomes in CF-lung transplant recipients colonized with Pseudomonas aeruginosa.

  • Participating Sites: University of Washington, Massachusetts General Hospital, University of Alberta, Nationwide Children’s Hospital, Stanford, Johns Hopkins, University of Alabama at Birmingham, University of Iowa, Ochsner Clinic Foundation, Washington University, University of Pittsburgh, Vanderbilt, University of California San Diego, UT Southwestern, University of North Carolina, Columbia University

  • Status: Data analysis and manuscript preparation

• Prior Infection or Colonization with Carbapenem-Resistant Enterobacteriaceae is Not an Absolute Contraindication to Solid Organ Transplantation

  • Principal Investigators: Stephanie Pouch, Shirish Huprikar

  • Description: Infection with carbapenem-resistant Enterobacteriaceae (CRE) is associated with significant morbidity and mortality in hospitalized patients.  Organ transplant recipients may be at higher risk for acquisition of CRE due to repeated healthcare exposures, severity of illness, and frequent receipt of antimicrobials.  Based on the supposition that transplant recipients have the potential to become infected with organisms with which they are colonized, the potential risk of transplanting patients with a history of asymptomatic colonization and/or prior infection with CRE also remains unknown and controversial.  This study aims to describe the outcomes in organ transplant recipients with pre-transplant CRE infection or colonization.

  • Participating Sites: Mount Sinai, Columbia University, University of Sao Paolo, Albert Einstein School of Medicine, University of Pittsburgh, Cornell University, Henry Ford Medical Center, University of Colorado, University Federal de Minas Gerais, Wake Forest

  • Status: Manuscript preparation

• Outcomes Associated with Carbapenem-Resistant Enterobacteriaceae Infection after Solid Organ Transplantation in a Multicenter Study

  • Principal Investigators: Anoma Nellore, Shirish Huprikar

  • Description: Carbapenem-resistant Enterobacteriaceae (CRE) infection is a threat to solid organ transplant (SOT) recipients and has been associated with poor outcomes in this patient population.  However, published literature has largely been limited to single center experiences.  This study aims to describe the epidemiology and outcomes associated with CRE infection in SOT recipients from a multicenter cohort.

  • Participating Sites: Mount Sinai, University of Alabama at Birmingham, University of Sao Paolo, Albert Einstein School of Medicine, Ochsner Clinic Foundation, Cornell University, Drexel University, University Federal de Minas Gerais, Henry Ford Medical Center, Wake Forest, Ohio State University, University of Michigan, Federal University of Rio de Janeiro, Yale University, Rush University

  • Status: Manuscript preparation

• A Multicenter Retrospective Review of Outcomes after Vancomycin-Resistant Enterococcus (VRE) Infections with Daptomycin MIC>4 and 2-4 Compared to Daptomycin Susceptible VRE Infections in Adult Abdominal Solid Organ Transplant Recipients

  • Principal Investigators: Anoma Nellore, Rachel Lee

  • Description: Solid organ transplant patients are at an increased risk of developing multi-drug resistant infections secondary to their immunocompromised state and the amount of time spent in the hospital.  While daptomycin non-susceptible enterococci (DNSE) infections in liver transplant recipients appear to be associated with significant morbidity and mortality, published data have been from single centers.  In addition, there are limited data available regarding the rates, outcomes, and associated risk factors for DNSE infections in the abdominal solid organ transplant (SOT) population.  The primary objective of this study is to compare outcomes between patients with DNSE (MIC >4) or vancomycin resistant enterococci (VRE) with daptomycin MIC 2-4 with daptomycin susceptible VRE (MIC <2) after adult abdominal SOT.  The outcomes of interest include graft loss and overall mortality within one year of infection.  The secondary objective is to describe the epidemiology of DNSE infections in abdominal organ transplant recipients, including recipients of liver, kidney, small bowel, and pancreas transplants. 

  • Participating Sites: University of Alabama at Birmingham, University of Pittsburgh, University of Virginia, Swedish Medical Center, Temple University, Ochsner Clinic Foundation, Duke University, Emory University

  • Status: Data collection and abstract preparation 

• Cardiac Device Infections due to Multi-Drug Resistant Bacteria and Fungi

  • Principal Investigators: Sarah Taimur

  • Description: The use of mechanical circulatory support (MCS) as bridge to transplant (BTT) has been steadily increasing.  However, infections remain a significant cause of morbidity and mortality in patients on MCS, and the risk of death from infection increases with time spent on device support.  The outcomes associated with left ventricular assist device (LVAD) infections and microbiologic spectrum has been well studied, though there is paucity of information in the published literature on MCS infections due to multi-drug resistant bacteria (MDRO). Further, little is known about the MCS infections due to fungal pathogens.  This study aims to investigate the prevalence, microbiology, and outcomes associated with infections associated with MCS used as BTT (LVAD/BiVAD/TAH) secondary to bacteria (MDRO and non-MDRO) and fungi.

  • Participating Sites: Mount Sinai 

  • Status: Protocol and case report form development