Real-time, random-access organ screening for carbapenem-resistant Enterobacterales (CRE) reduces CRE- associated, donor-derived infection mortality in recipients

Purpose: Donor-derived infection (DDI) has become an important factor affecting the prognosis of lung transplantation patients. The risks versus benefits of using donor organs infected with multidrug-resistant organisms (MDRO), especially carbapenem-resistant Enterobacterales (CRE), are frequently debated. Traditional microbial culture and antimicrobial susceptibility testing at present fail to meet the needs of quick CRE determination for donor lung before acquisition. In this study, we explored a novel accurate screening method by using Xpert® Carba-R assay for CRE in donor lungs in a real-time manner to reduce CRE-associated DDI mortality. Methods: This study was registered on chictr.org.cn (ChiCTR2100053687) on November, 2021. In the Xpert Carba-R screening group, donor lungs were screened for CRE infection by Xpert Carba-R test on bronchoalveolar lavage fluid (BALF) before acquisition. If the result was negative, donor lung acquisition and subsequent lung transplantation were performed. In the control group, the recipients underwent lung transplants without Xpert Carba-R screening. The incidence and mortality of CRE-associated DDI were collected and contrasted between the two groups. Results: Multivariate analysis showed that CRE-related death due to DDI within 60 days was significantly lower in the Xpert Carba-R screening group than that in the control group (OR = 0.049, 95% CI = 0.003-0.736, p = 0.029). Conclusion: Real-time CRE screening of donor lungs before transplantation at the point of care by the Xpert Carba-R helps clinicians formulate lung transplantation strategies quickly and reduces the risk of subsequent CRE infection improving the prognosis of lung transplantation.