PMID- 29718144
OWN - NLM
STAT- MEDLINE
DCOM- 20191104
LR  - 20191104
IS  - 1537-6591 (Electronic)
IS  - 1058-4838 (Print)
IS  - 1058-4838 (Linking)
VI  - 67
IP  - 6
DP  - 2018 Aug 31
TI  - Genomic Surveillance Reveals Diversity of Multidrug-Resistant Organism 
      Colonization and Infection: A Prospective Cohort Study in Liver Transplant 
      Recipients.
PG  - 905-912
LID - 10.1093/cid/ciy199 [doi]
AB  - BACKGROUND: Multidrug-resistant organisms (MDROs) are an important cause of 
      morbidity and mortality after solid organ transplantation. We aimed to 
      characterize MDRO colonization dynamics and infection in liver transplant (LT) 
      recipients through innovative use of active surveillance and whole-genome 
      sequencing (WGS). METHODS: We prospectively enrolled consecutive adult patients 
      undergoing LT from March 2014 to March 2016. Fecal samples were collected at 
      multiple timepoints from time of enrollment to 12 months posttransplant. Samples 
      were screened for carbapenem-resistant Enterobacteriaceae (CRE), 
      Enterobacteriaceae resistant to third-generation cephalosporins (Ceph-RE), and 
      vancomycin-resistant enterococci. We performed WGS of CRE and selected Ceph-RE 
      isolates. We also collected clinical data including demographics, transplant 
      characteristics, and infection data. RESULTS: We collected 998 stool samples and 
      119 rectal swabs from 128 patients. MDRO colonization was detected in 86 (67%) 
      patients at least once and was significantly associated with subsequent MDRO 
      infection (0 vs 19.8%, P = .002). Child-Turcotte-Pugh score at LT and duration of 
      post-LT hospitalization were independent predictors of both MDRO colonization and 
      infection. Temporal dynamics differed between MDROs with respect to onset of 
      colonization, clearance, and infections. We detected an unexpected diversity of 
      CRE colonizing isolates and previously unrecognized transmission that spanned 
      Ceph-RE and CRE phenotypes, as well as a cluster of mcr-1-producing isolates. 
      CONCLUSIONS: Active surveillance and WGS showed that MDRO colonization is a 
      highly dynamic and complex process after LT. Understanding that complexity is 
      crucial for informing decisions regarding MDRO infection control, use of 
      therapeutic decolonization, and empiric treatment regimens.
FAU - Macesic, Nenad
AU  - Macesic N
AD  - Division of Infectious Diseases, Columbia University Medical Center, New York, 
      New York.
AD  - Central Clinical School, Monash University, Melbourne, Victoria, Australia.
FAU - Gomez-Simmonds, Angela
AU  - Gomez-Simmonds A
AD  - Division of Infectious Diseases, Columbia University Medical Center, New York, 
      New York.
FAU - Sullivan, Sean B
AU  - Sullivan SB
AD  - Division of Infectious Diseases, Columbia University Medical Center, New York, 
      New York.
AD  - Microbiome and Pathogen Genomics Core, Department of Medicine, Columbia 
      University Medical Center.
FAU - Giddins, Marla J
AU  - Giddins MJ
AD  - Division of Infectious Diseases, Columbia University Medical Center, New York, 
      New York.
AD  - Microbiome and Pathogen Genomics Core, Department of Medicine, Columbia 
      University Medical Center.
FAU - Ferguson, Samantha A
AU  - Ferguson SA
AD  - Division of Infectious Diseases, Columbia University Medical Center, New York, 
      New York.
FAU - Korakavi, Gautam
AU  - Korakavi G
AD  - Division of Infectious Diseases, Columbia University Medical Center, New York, 
      New York.
FAU - Leeds, David
AU  - Leeds D
AD  - Division of Infectious Diseases, Columbia University Medical Center, New York, 
      New York.
FAU - Park, Sarah
AU  - Park S
AD  - Division of Infectious Diseases, Columbia University Medical Center, New York, 
      New York.
FAU - Shim, Kevin
AU  - Shim K
AD  - Division of Infectious Diseases, Columbia University Medical Center, New York, 
      New York.
FAU - Sowash, Madeleine G
AU  - Sowash MG
AD  - Division of Infectious Diseases, Columbia University Medical Center, New York, 
      New York.
FAU - Hofbauer, Melanie
AU  - Hofbauer M
AD  - Division of Infectious Diseases, Columbia University Medical Center, New York, 
      New York.
FAU - Finkel, Ryan
AU  - Finkel R
AD  - Division of Infectious Diseases, Columbia University Medical Center, New York, 
      New York.
FAU - Hu, Yue
AU  - Hu Y
AD  - Division of Infectious Diseases, Columbia University Medical Center, New York, 
      New York.
FAU - West, Jared
AU  - West J
AD  - Division of Infectious Diseases, Columbia University Medical Center, New York, 
      New York.
FAU - Toussaint, Nora C
AU  - Toussaint NC
AD  - New York Genome Center.
FAU - Greendyke, William G
AU  - Greendyke WG
AD  - Division of Infectious Diseases, Columbia University Medical Center, New York, 
      New York.
FAU - Miko, Benjamin A
AU  - Miko BA
AD  - Division of Infectious Diseases, Columbia University Medical Center, New York, 
      New York.
FAU - Pereira, Marcus R
AU  - Pereira MR
AD  - Division of Infectious Diseases, Columbia University Medical Center, New York, 
      New York.
FAU - Whittier, Susan
AU  - Whittier S
AD  - Clinical Microbiology Laboratory, Department of Pathology and Cell Biology.
FAU - Verna, Elizabeth C
AU  - Verna EC
AD  - Division of Digestive and Liver Disease, Columbia University Medical Center, New 
      York, New York.
FAU - Uhlemann, Anne-Catrin
AU  - Uhlemann AC
AD  - Division of Infectious Diseases, Columbia University Medical Center, New York, 
      New York.
AD  - Microbiome and Pathogen Genomics Core, Department of Medicine, Columbia 
      University Medical Center.
LA  - eng
GR  - R01 AI116939/AI/NIAID NIH HHS/United States
GR  - T32 AI100852/AI/NIAID NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Clin Infect Dis
JT  - Clinical infectious diseases : an official publication of the Infectious Diseases 
      Society of America
JID - 9203213
SB  - IM
MH  - Aged
MH  - Bacteria/drug effects/*genetics/isolation & purification
MH  - Carbapenem-Resistant Enterobacteriaceae/drug effects/genetics/isolation & 
      purification
MH  - Carrier State/*microbiology
MH  - Cross Infection
MH  - *Drug Resistance, Multiple, Bacterial
MH  - Feces/microbiology
MH  - Female
MH  - *Genetic Variation
MH  - Genomics
MH  - Humans
MH  - *Liver Transplantation
MH  - Male
MH  - Methicillin-Resistant Staphylococcus aureus/drug effects/genetics/isolation & 
      purification
MH  - Middle Aged
MH  - Prospective Studies
MH  - Sentinel Surveillance
MH  - Transplant Recipients
MH  - Vancomycin-Resistant Enterococci/drug effects/genetics/isolation & purification
MH  - Whole Genome Sequencing
PMC - PMC6117442
EDAT- 2018/05/03 06:00
MHDA- 2019/11/05 06:00
PMCR- 2019/08/31
CRDT- 2018/05/03 06:00
PHST- 2017/11/20 00:00 [received]
PHST- 2018/03/22 00:00 [accepted]
PHST- 2018/05/03 06:00 [pubmed]
PHST- 2019/11/05 06:00 [medline]
PHST- 2018/05/03 06:00 [entrez]
PHST- 2019/08/31 00:00 [pmc-release]
AID - 4990041 [pii]
AID - ciy199 [pii]
AID - 10.1093/cid/ciy199 [doi]
PST - ppublish
SO  - Clin Infect Dis. 2018 Aug 31;67(6):905-912. doi: 10.1093/cid/ciy199.