{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T08:36:46Z","timestamp":1765355806909},"reference-count":37,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2014,4,12]],"date-time":"2014-04-12T00:00:00Z","timestamp":1397260800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2014,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p><jats:italic><jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>cinetobacter baumannii<\/jats:italic> is a leading agent of healthcare\u2010associated infection. The objective of this study was to evaluate cases of colonization or infection with polymyxin\u2010resistant <jats:italic><jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>.\u00a0baumannii<\/jats:italic> (<jats:styled-content style=\"fixed-case\">PRAB<\/jats:styled-content>) in liver transplant recipients and to identify the risk factors for the acquisition of <jats:styled-content style=\"fixed-case\">PRAB<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We evaluated all patients undergoing liver transplantation (<jats:styled-content style=\"fixed-case\">LT<\/jats:styled-content>) between January and November of 2011. The exclusion criterion was death within the first 72\u00a0h after transplant. Patients were screened for <jats:styled-content style=\"fixed-case\">PRAB<\/jats:styled-content> through weekly rectal and inguinal swabs during their stay in the intensive care unit (<jats:styled-content style=\"fixed-case\">ICU<\/jats:styled-content>) and at <jats:styled-content style=\"fixed-case\">ICU<\/jats:styled-content> discharge. Patients who came from other hospitals or had been treated in the emergency room for &gt;72\u00a0h were screened at <jats:styled-content style=\"fixed-case\">ICU<\/jats:styled-content> admission. The minimum inhibitory concentrations (<jats:styled-content style=\"fixed-case\">MIC<\/jats:styled-content>s) for polymyxins were determined by broth microdilution, and clonality was determined by pulsed\u2010field gel electrophoresis. The stepwise logistic regression was used to identify risk factors related to acquisition of <jats:styled-content style=\"fixed-case\">PRAB<\/jats:styled-content>, and Cox forward regression used to identify risk factors for 60\u2010day mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We evaluated 65 patients submitted to <jats:styled-content style=\"fixed-case\">LT<\/jats:styled-content>, among whom <jats:styled-content style=\"fixed-case\">PRAB<\/jats:styled-content> was isolated in 7, 4 of whom developed infection. The <jats:styled-content style=\"fixed-case\">MIC<\/jats:styled-content>s for polymyxin E ranged from 16 to 128\u00a0mg\/mL. All patients with <jats:styled-content style=\"fixed-case\">PRAB<\/jats:styled-content> required dialysis. The median time of polymyxin use before <jats:styled-content style=\"fixed-case\">PRAB<\/jats:styled-content> isolation was 21\u00a0days. These 4 included 1 case of primary bloodstream infection (<jats:styled-content style=\"fixed-case\">BSI<\/jats:styled-content>), which was treated with the carbapenem\u2010polymyxin combination; 1 case of surgical site infection, which was treated with gentamicin, polymyxin, ampicillin\u2010sulbactam, and tigecycline; and 2 cases of pneumonia, treated with the combination of carbapenem\u2010polymyxin. In the case of <jats:styled-content style=\"fixed-case\">BSI<\/jats:styled-content> and in 1 of the cases of pneumonia, the treatment was considered successful. Mortality was 71% among the cases, compared with 33% among the non\u2010cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In the final model of the survival analysis, <jats:styled-content style=\"fixed-case\">PRAB<\/jats:styled-content> colonization or infection after <jats:styled-content style=\"fixed-case\">LT<\/jats:styled-content> was independently associated with mortality. One predominant clone was identified. The only risk factor identified in the multivariate analysis was polymyxin use. <jats:styled-content style=\"fixed-case\">PRAB<\/jats:styled-content> was an agent with high mortality, and the most important risk factor associated with colonization or infection for such bacterium was polymyxin use.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tid.12210","type":"journal-article","created":{"date-parts":[[2014,4,12]],"date-time":"2014-04-12T06:50:48Z","timestamp":1397285448000},"page":"369-378","source":"Crossref","is-referenced-by-count":19,"title":["Polymyxin use as a risk factor for colonization or infection with polymyxin\u2010resistant <i><scp>A<\/scp>cinetobacter baumannii<\/i> after liver transplantation"],"prefix":"10.1111","volume":"16","author":[{"given":"M.P.","family":"Freire","sequence":"first","affiliation":[{"name":"Infection Control Service Hospital das Cl\u00ednicas University of S\u00e3o Paulo School of Medicine S\u00e3o Paulo 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