The Impact Of Colonization by Multi Drug Resistant Bacteria on Graft Survival, Risk of Infection, and Mortality in Recipients of Solid Organ Transplant: Systematic Review and Meta-analysis

Abstract

Background: Colonization with multi-drug resistant bacteria (MDR) in solid organ transplant (SOT) recipients increases the risk of post-transplant bacterial infection. The impact of MDR colonization on graft survival and mortality is not well established. Methods: We searched PROSPERO, OVID Medline, Ovid EMBASE, Wiley Cochrane Library, ProQuest dissertations and Theses Global and SCOPUS, from inception until March 20, 2023. Cohort and case control studies with adult SOT colonized with Methicillin resistant Staphylococcus aureus (MRSA), Vancomycin- resistant Enterococci (VRE), Extended-spectrum beta-lactamase (ESBL), AmpC producing bacteria, carbapenem resistant Enterobacteriaceae (CRE), or MDR Pseudomonas were included. Pairs of reviewers screened abstracts and full studies for inclusion and extracted data independently. We used RevMan to conduct a meta-analysis using random-effects models to calculate the pooled odds ratio (OR) and 95% confidence interval (CI) for mortality, infection, and graft loss. We assessed statistical heterogeneity using I 2 statistic, bias assessment with Newcastle-Ottawa Scale (NOS) and rated the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation methodology. The protocol is registered with (CRD42022290011). Results: A meta-analysis of 33 cohort and 6 case control studies included 4077 SOT recipients with MDR colonization. Liver transplant (25) and VRE colonization (14) studies constituted the most common organ and MDR bacterium, respectively. Death (OR= 2.35, 95%CI 1.63-3.38) and infection within one year (OR 10.74, 95%CI 7.56-12.26) were significantly higher among MDR colonized transplant recipients across all types of transplant (p<0.001 and I2= 58%). MDR colonization did not increase the risk of graft loss (OR=1.17, 95%CI 0.81-1.69; p=0.41, I2= 0%). Conclusion: We identified low certainty of evidence that MDR colonization in SOT increases the odds of infection and death but not graft loss. Actions for preventing of colonization in transplant candidates are warranted.