Carbapenem-resistant Enterobacterales in solid organ transplant recipients

Carbapenem-resistant Enterobacterales (CRE) are an important threat to the health of solid organ transplant recipients (SOTr); data comparing outcomes of SOTr with CRE to non-SOTr with CRE are lacking. A matched cohort study was performed within two prospective, multicenter, cohort studies (CRACKLE, CRACKLE-2). The epidemiology, desirability of outcome rankings (DOOR) outcomes, and mortality of SOTr and non-SOTr hospitalized in the United States (December 2011 - August 2017) with clinical isolates with Centers for Disease Control and Prevention-defined CRE were compared. In total, 121 SOTr and 242 matched non-SOTr were included. Fifty one percent of isolates met infection criteria. SOTr were younger (p<0.001), less acutely ill (p=0.029), less often had a malignancy history (p=0.006), and more often were admitted from home (p<0.001) than non-SOTr. SOTr had more favorable adjusted DOOR outcomes; a randomly selected SOTr had a 58% (95% CI 53%-64%) probability of a better outcome as compared to a randomly selected non-SOTr. All-cause 30-day mortality was 14% (17/121) in SOTr vs. 25% (60/242) in non-SOTr, p=0.018. After stabilized inverse-probability weighted adjustment, SOTr had a 7% lower 30-d mortality risk than non-SOTr (95% CI -15%, 1%). SOTr with CRE do not have worse outcomes than matched patients without transplant history.