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Prospective cohort study in kidney (n\u2009=\u2009142), liver (n\u2009=\u200998) or kidney\/pancreas (n\u2009=\u20097) transplant recipients between 2014 and 2018 in seven Spanish hospitals. We included 531 MDR-E isolates from rectal swabs obtained before transplantation and weekly for 4\u20136\u00a0weeks after the procedure and 10 MDR-E from clinical samples related to an infection. Overall, 46.2%\n                    <jats:italic>Escherichia coli<\/jats:italic>\n                    , 35.3%\n                    <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                    , 6.5%\n                    <jats:italic>Enterobacter cloacae<\/jats:italic>\n                    , 6.3%\n                    <jats:italic>Citrobacter freundii<\/jats:italic>\n                    and 5.7% other species were isolated. The number of patients with MDR-E colonization post-transplantation (176; 71.3%) was 2.5-fold the number of patients colonized pre-transplantation (71; 28.7%). Extended-spectrum \u03b2-lactamases (ESBLs) and carbapenemases were detected in 78.0% and 21.1% of MDR-E isolates respectively. In nine of the 247 (3.6%) transplant patients, the microorganism causing an infection was the same strain previously cultured from surveillance rectal swabs. In our study we have observed a low rate of MDR-E infection in colonized patients 4\u20136\u00a0weeks post-transplantation.\n                    <jats:italic>E. coli<\/jats:italic>\n                    producing\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>CTX-M-G1<\/jats:sub>\n                    and\n                    <jats:italic>K. pneumoniae<\/jats:italic>\n                    harbouring\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>OXA-48<\/jats:sub>\n                    alone or with\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>CTX-M-G1<\/jats:sub>\n                    were the most prevalent MDR-E colonization strains in SOT recipients.\n                  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