A comprehensive evaluation of risk factors for mortality, infection and colonization associated with CRGNB in adult solid organ transplant recipients: a systematic review and meta-analysis

Abstract

Background

The burden of carbapenem-resistant gram-negative bacteria (CRGNB) among solid organ transplant (SOT) recipients has not been systematically explored. Here, we discern the risk factors associated with CRGNB infection and colonization in SOT recipients.

Methods

This study included observational studies conducted among CRGNB-infected SOT patients, which reported risk factors associated with mortality, infection or colonization. Relevant records will be searched in PubMed, Embase and Web of Science for the period from the time of database construction to 1 March 2023.

Results

A total of 23 studies with 13,511 participants were included, enabling the assessment of 27 potential risk factors. The pooled prevalence of 1-year mortality among SOT recipients with CRGNB was 44.5%. Prolonged mechanical ventilation, combined transplantation, reoperation and pre-transplantation CRGNB colonization are salient contributors to the occurrence of CRGNB infections in SOT recipients. Renal replacement therapy, post-LT CRGNB colonization, pre-LT liver disease and model for end-stage liver disease score increased the risk of infection. Re-transplantation, carbapenem use before transplantation and ureteral stent utilization increaesd risk of CRGNB colonization.

Conclusion

Our study demonstrated that SOT recipients with CRGNB infections had a higher mortality risk. Invasive procedure may be the main factor contribute to CRGNB infection.

Keywords:

• Solid organ transplant
• CRGNB
• infection
• colonization
• mortality

Acknowledgement

Not applicable.

Authors contributions

SYG and XLH developed a review protocol with critical input from XLZ. SJT designed the search strategy in consultation with the QL. Title and abstract screening was conducted by two independent reviewers in TW and YL. A full-text review of the studies selected by title and abstract was conducted by YFZ and YDC. HQH made the final decisions with respect to study inclusion or exclusion. JH and HLQ performed the data extraction and risk of bias assessment of the included studies. SYG and XLH carried out all analyses and prepared the first draft of the manuscript, which was revised by all the authors until finalization.

Ethics approval and patient consent

Not applicable.

Compliance with Ethics guidelines

This article is based on previous studies and does not contain any new studies with human participants or animals performed by any of the authors.

Consent for publication

Not applicable.

Disclosure statement

The authors declare that they have no competing interests.

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials.

Additional information

Funding

No funding.