Figure 3.

Schematic figure of dynamics of multidrug-resistant organism (MDRO) colonization. MDRO colonization has complex dynamics, with patients following different trajectories. In this schematic figure, 5 patients with typical colonization trajectories are shown. In the first example, the patient had rapid clearance after early posttransplant colonization with Enterobacteriaceae resistant to third-generation cephalosporins (Ceph-RE). In the second example, the patient clearance of initial colonization with Escherichia coli sequence type (ST) 10 but subsequent recolonization with E. coli ST38. The third example is of late colonization, in this case with mcr-1–producing E. coli ST117, likely due to healthcare-associated transmission. The fourth example shows a patient persistently colonized with Klebsiella pneumoniae ST258. The final example shows a patient colonized with Ceph-RE K. pneumoniae ST340, with transition to colonization with carbapenem-resistant Enterobacteriaceae K. pneumoniae ST340. Reversion to Ceph-RE colonization is associated with a change in sequence type to K. pneumoniae ST2564. Abbreviations: CRE, carbapenem-resistant Enterobacteriaceae; MDR-GNB, multidrug-resistant gram-negative bacteria.