Fatal case of donor-derived colistin-resistant carbapenemase-producing Klebsiella pneumoniae transmission in cardiac transplantation

Abstract

Herein we report a fatal case of donor-derived transmission of XDR-resistant carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) in cardiac transplantation. A 59-year-old male patient with non-obstructive hypertrophic cardiomyopathy underwent heart transplantation. On day 5 post-operation, blood cultures from the donor were positive for colistin-resistant carbapenemase-producing K. pneumoniae (ColR KPC-Kp) susceptible only to amikacin. Recipient blood cultures were also positive for ColR KPC-Kp with the same sensitivity profile as the donor isolate with an identical PFGE pattern. The patient was treated with double-carbapenems and amikacin. The patient evolved to pericarditis, osteomyelitis, and pulmonary necrosis, all fragment cultures positive for the same agent. The patient developed septic shock, multiple organ failure and died on day 50 post-transplantation. Based on current microbiological scenario worldwide the possibility of transmitting multidrug resistant (MDR) organisms should be considered.

Review of the impact of donor characteristics on pediatric heart transplant outcomes

“…More specifically, Amdani et al reported on pediatric heart transplant recipients from blood culture‐positive donors showing there was no difference in survival or post‐transplant complications with these donors compared to donors with negative blood cultures. However, with the emergence of multi‐drug‐resistant (MDR) organisms, transmission from donor to recipient of these difficult‐to‐treat organisms has been reported in adult heart transplantation, although organs from donors with some MDR organisms including carbapenamase‐resistant Klebsiella pneumoniae have been safely used in at least one adult heart transplant recipient with targeted peri‐operative and post‐operative antimicrobial administration . To date, no pediatric reports using donors with MDR bacterial infections appear in the literature and donors with these organisms should be considered with caution focusing on the therapies available to treat a recipient should a donor‐derived infection develop.…”

Double-carbapenem therapy in the treatment of multidrug resistant Gram-negative bacterial infections: a systematic review and meta-analysis

“…Overall, 28 studies were selected for fulltext review, and 21 studies met our inclusion criteria. For these 21 studies, three trials [33][34][35] were cohort or casecontrol studies, and 18 reports [26,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52] were case series or case reports. The flow diagram (Fig.…”

Multidrug-Resistant Organisms: Posttransplant Management for Extended-Spectrum Beta-Lactamase Producers and Carbapenem-Resistant Enterobacterales

“…However, none of the organ recipients who received appropriate antibiotic therapy, defined as targeted therapy initiated within 7 days of transplantation and continued for at least 7 days, developed an infection with the resistant organism [56]. In the literature, there have been at least nine cases of reported CRE transmission from donor to organ recipient [54,57]. Rapid diagnosis and communication with the recipient's healthcare team can significantly impact empiric antibiotic regimens and mortality [54].…”