Impact of carbapenem‐resistant Klebsiella pneumoniae (CR‐KP) infections in kidney transplantation. Issue 6 (28th September 2017)

• Record Type: Journal Article
• Authors: Varotti, Giovanni; Dodi, Ferdinando; Terulla, Alessia; Santori, Gregorio; Mariottini, Gabriele; Bertocchi, Massimo; Marchese, Anna; Fontana, Iris
• Is Part Of: Transplant infectious disease. Volume 19:Issue 6(2017)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2017-09-28
• Subjects: carbapenem‐resistant Klebsiella pneumoniae -- kidney transplant; Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.12757
• Languages: English
• ISSNs: 1398-2273

Abstract

Abstract: Background: Carbapenem‐resistant Klebsiella pneumoniae (CR‐KP) infections in solid organ transplant patients are progressively increasing and are associated with worse outcomes, although potential risk factors and therapeutic strategies are still not well defined. Methods: We conducted a retrospective matched‐pair analysis in which we compared 26 recipients CR‐KP‐positive after kidney transplantation (KT) with 52 CR‐KP‐negative patients transplanted in the same period, during a CR‐KP outbreak that occurred in our hospital. Twenty‐one patients (80%) received a combined antibiotic treatment. At the end of the follow‐up, of the 26 CR‐KP infected patients, 11 (42.3%) experienced at least one episode of re‐infection, 9 (34.6%) remained colonized, and 6 (23.0%) had a symptomatic infection. Two of the 11 patients with re‐infection died, while 9 were colonized at the end of the study. Results: A significantly better patient ( P = .043) and graft ( P < .001) survival was observed in CR‐KP‐negative patients. Univariate analysis identified the following variables as potential risk factors associated with CR‐KP infection after KT: lower body mass index ( P = .020); higher creatinine levels at post‐transplant days 7 ( P = .009), 15 ( P = .026), and 30 ( P = .019); longer hospital stay ( P = .007); longer cold ischemia time ( P = .004); delayed graft function ( P = .020); and higher Clavien‐Dindo score ( P = .006). Conclusion: The study confirmed that a CR‐KP positivity may affect the outcome of a kidney transplant population. In severe CR‐KP infections with sepsis, a combined antibiotic treatment seems to be advisable.