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Routine surveillance cultures (SCs) were performed using axillary\u2010perineum\u2010rectal swabs with immunochromatographic tests. A case\u2010control study identified risk factors for CRPA acquisition. Pulsed\u2010field gel electrophoresis and whole genome sequencing characterized the strains.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After reopening, new cases arose from patients previously colonized, peaking 18 months later. A total of 67 KT recipients with CRPA\u2010IMP\u2010producing strains were identified. All except one sequenced strain belonged to the ST446 clone, differing by a maximum of 110 single nucleotide polymorphisms. Forty\u2010five (67.2%) cases were identified through SC, with 45.7% showing intermittent SC positivity. Patients remained colonized for up to 623 days. Twenty\u2010four (35.8%) patients had infections, with the most common site being the urinary tract. Identified risk factors included older age, deceased donor, re\u2010transplantation, reoperation, carbapenem or quinolone use, lymphopenia, hospital stay &gt;10 days, and the first 60 days post\u2010KT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>KT recipients can harbor CRPA for extended periods, and detecting CRPA\u2010colonized patients is challenging. These characteristics highlight the patient as the major source and a critical point in outbreak control.\n<jats:boxed-text content-type=\"graphic\" position=\"anchor\"><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/tid14414-gra-0001-m.png\"><jats:alt-text>image<\/jats:alt-text><\/jats:graphic><\/jats:boxed-text><\/jats:p><\/jats:sec>","DOI":"10.1111\/tid.14414","type":"journal-article","created":{"date-parts":[[2024,12,5]],"date-time":"2024-12-05T08:06:18Z","timestamp":1733385978000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Recurrent Outbreak of Carbapenem\u2010Resistant IMP\u20101\u2010Producing <i>Pseudomonas aeruginosa<\/i> in Kidney Transplant Recipients: The Impact of Prolonged Patient Colonization"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9691-192X","authenticated-orcid":false,"given":"Maristela P.","family":"Freire","sequence":"first","affiliation":[{"name":"Working Committee for Hospital Epidemiology and Infection Control University of S\u00e3o Paulo School of Medicine Hospital das Cl\u00ednicas  Sao Paulo Brazil"},{"name":"Department of Infectious Diseases University of S\u00e3o Paulo School of Medicine Hospital das Cl\u00ednicas  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos Henrique","family":"Camargo","sequence":"additional","affiliation":[{"name":"Bacteriology Division Instituto Adolfo Lutz  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laina","family":"Bubach","sequence":"additional","affiliation":[{"name":"Working Committee for Hospital Epidemiology and Infection Control University of S\u00e3o Paulo School of Medicine Hospital das Cl\u00ednicas  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda Yaeko","family":"Yamada","sequence":"additional","affiliation":[{"name":"Bacteriology Division Instituto Adolfo Lutz  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernanda","family":"Spad\u00e3o","sequence":"additional","affiliation":[{"name":"Working Committee for Hospital Epidemiology and Infection Control University of S\u00e3o Paulo School of Medicine Hospital das Cl\u00ednicas  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina Andrade","family":"Lopes","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases University of S\u00e3o Paulo School of Medicine Hospital das Cl\u00ednicas  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio Tavares","family":"Sacchi","sequence":"additional","affiliation":[{"name":"Strategic Laboratoty Instituto Adolfo Lutz  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karoline Rodrigues","family":"Campos","sequence":"additional","affiliation":[{"name":"Bacteriology Division Instituto Adolfo Lutz  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlon Benedito Nascimento","family":"Santos","sequence":"additional","affiliation":[{"name":"Bacteriology Division Instituto Adolfo Lutz  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Otto Reusing","family":"Junior","sequence":"additional","affiliation":[{"name":"Department of Urology Renal Transplantation Unit, University of S\u00e3o Paulo School of Medicine Hospital das Cl\u00ednicas  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Paula","family":"Cury","sequence":"additional","affiliation":[{"name":"Department of Central Laboratory Microbiology Laboratory University of S\u00e3o Paulo School of Medicine Hospital das Cl\u00ednicas  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavia","family":"Rossi","sequence":"additional","affiliation":[{"name":"Department of Central Laboratory Microbiology Laboratory University of S\u00e3o Paulo School of Medicine Hospital das Cl\u00ednicas  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelina da Motta P. 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