Carbapenem-Resistant Klebsiella Pneumoniae Infections Early After Liver Transplantation: A Single-Center Experience

Mazza, E.; Prosperi, M.; Panzeri, M.F.; Limuti, R.; Nichelatti, Michele; Gasperi, Andrea De

doi:10.1016/j.transproceed.2017.02.028

Cited by 22 publications

(23 citation statements)

References 10 publications

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“…In sensitivity analysis, excluding two studies [31,42] with an unclear risk of bias (Additional Table 6), the analysis still found a significantly increased risk of mortality among patients with CR infections compared to controls (summary OR: (Table 2). Additional subgroup meta-analysis of unadjusted mortality data at different time points similarly found a significantly higher risk of mortality in patients with CR infections than in controls: in-hospital/≤30-day mortality (4 studies [13,32,40,45]; summary OR: 6.08; 95% CI: 3.83, 9.66; I 2 = 0.0%) and longer follow-up (greater than 6 months) (5 studies [31,37,38,40,42]; summary OR: 6.56; 95% CI: 2.81, 15.33; I 2 = 51.3%) ( Table 2). Meta-analysis of the five studies that also reported multivariable data [31,37,38,40,45] (adjusted for various confounders (Additional Table 5)) compared 239 patients with CR infections to 1097 controls and found a significantly increased risk of mortality (summary HR: 4.67; 95% CI: 2.18, 9.99; I 2 = 77.7%) (Fig.…”

Section: Meta-analysis Of Mortality Data From Studies Of Totally Highmentioning

confidence: 99%

“…Twenty-five studies reported mortality in patients with CR infections [13,[22][23][24][25][26][27][28][29][30][31][32][34][35][36][37][38][39][40][41][42][43][44][45][46]. Of these, 12 compared mortality in patients with CR infections with mortality in patients without a CR infection (e.g., CS infection, no CR infection, no infection), which permitted the calculation of unadjusted ORs [13, 22, 27-30, 32, 36-38, 42, 45], 11 provided results for patients with CR infection only [23-26, 34, 35, 39, 41, 43, 44, 46], and two [31,40] reported 30-day mortality for patients with CR infection only and either 6-month or 1-year mortality for both patients with CR infection and patients with no CR infection.…”

Section: Mortalitymentioning

confidence: 99%

“…Mortality was reported across pathogen types and type of comparator arm. Twelve studies reported data for high-risk patients exclusively (solid organ transplant, hematologic malignancy, and open-heart surgery patients); of these, eight studies compared mortality in CR infected patients with controls [13,31,32,37,38,40,42,45], and six studies provided results for the CR infection patients only [24,31,34,40,41,46] (two studies reported both comparative and non-comparative data, depending on the outcome).…”

Section: Mortalitymentioning

confidence: 99%

“…The eight studies that focused on high-risk patients only and compared CR infections with controls all provided unadjusted data, and five of these studies also reported adjusted data. Meta-analysis was conducted using the eight studies which reported unadjusted data [13,31,32,37,38,40,42,45] and found a significant increase in mortality risk for high-risk patients with CR K. pneumoniae (CRKP) infections (n = 290) (summary OR: 5.85; 95% CI: 3.69, 9.26; I 2 = 19.8%) compared to controls (either patients with CS K. pneumoniae [CSKP] or patients without an infection [n = 1062]) ( Fig. 2).…”

Section: Meta-analysis Of Mortality Data From Studies Of Totally Highmentioning

confidence: 99%

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Burden of carbapenem non-susceptible infections in high-risk patients: systematic literature review and meta-analysis

Avendano

Raman

Chan

2020

Antimicrob Resist Infect Control

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Background Owing to their resistance to an important class of antibiotics, the prevention and treatment of carbapenem-resistant (CR)/non-susceptible Gram-negative (GN) infections has become an important public health objective. We conducted a systematic review and meta-analysis of published literature to evaluate the burden of CR GN infections, focusing on high-risk patients such as transplant recipients, or patients with cancer, renal impairment, or sepsis. Methods MEDLINE®, Cochrane Central, and Embase® were searched between 2010 and March 2019. Abstracts and full-text articles were screened in duplicate. Random effects meta-analysis was conducted when reported outcomes were sufficiently similar. Results Twenty-six publications were eligible. Meta-analyses found increased mortality associated with CR infections among high-risk patients in both unadjusted analysis (8 studies; summary unadjusted odds ratio [OR]: 5.85; 95% confidence interval [CI]: 3.69, 9.26; I2 = 19.8%) and adjusted analysis (5 studies; summary hazard ratio [HR]: 4.67; 95% CI: 2.18, 9.99; I2 = 77.7%), compared to patients with carbapenem-susceptible (CS) infections or no infection. Increased mortality was also seen in subgroup analyses by length of follow-up (either short-term or long-term) or causative pathogen. A limited number of studies found that CR GN infections increased the risk for mechanical ventilation, adverse events such as graft failure or acute rejection in solid organ transplant recipients, increased renal failure or nephrotoxicity, and an increase in readmissions and costs, though the findings reported in the literature were not consistent. Conclusion This systematic literature review and meta-analysis indicates that CR GN infections in high-risk patients are associated with increased mortality, emphasizing the need for antimicrobial stewardship and infection control in hospitals which treat high-risk patients and for the development of effective antimicrobials with favorable efficacy and safety profiles for the treatment of CR GN infections.

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Section: Meta-analysis Of Mortality Data From Studies Of Totally Highmentioning

confidence: 99%

Section: Mortalitymentioning

confidence: 99%

Section: Mortalitymentioning

confidence: 99%

Section: Meta-analysis Of Mortality Data From Studies Of Totally Highmentioning

confidence: 99%

See 2 more Smart Citations

Burden of carbapenem non-susceptible infections in high-risk patients: systematic literature review and meta-analysis

Avendano

Raman

Chan

2020

Antimicrob Resist Infect Control

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“…Most of current antibiotics utilized in practice have no therapeutic effect on CRKP infection after renal transplantation, with the mortality can be as high as 40% to 70% [55,56], and the 30-days mortality rate was 50% to 60% [57,58]. In recent years, the resistance rate of CRKP to polymyxin and tigecycline was increasing [59,60].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Kidney Transplantation Using Organs From A Donor Infected with Carbapenem-Resistant Klebsiella Pneumoniae in A Chinese Hospital: A Molecular Epidemiological Study

Wang

Jiang

et al. 2020

Preprint

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Abstract Introduction: Although the high mortality rates and adverse events related to the post-operative infection have been extensively reported worldwide, to date, few studies have investigated the transmission of CRKP isolates between the Kidney Transplant Donors (KTDs) and Kidney Transplant Recipients (KTRs) with the aid of genetic and molecular study in mainland China. We sought to describe the antibiotic susceptibility, microbiological and clinical characteristics of CRKPs in donors and recipients admitted to our hospital, focusing on the clonal transmission between the donor and recipient in renal transplantation.Method: A retrospective analysis of clinical data of CRKP-BSIs in KTRs and the corresponding cadaveric donors admitted to a Chinese hospital in Beijing, China, between January 1, 2012 and December 31, 2017 was performed. The microbiology, clinical characteristics, antimicrobial susceptibility of both donors and recipients were analyzed. The genetic relatedness and sequencing type of the strains was determined by whole genome sequencing.Results: During the study period, there are total 297 KTRs from DCD performed in our hospital. Ten incidences of CRKP-BSIs in KTRs, and one CSKP-urinary tract infection in R3, were identified, and two of them (R1, R4) from the same foreign hospital. The incidence of CRKP-BSIs in the early stage (within 3 months) following kidney transplantation (KTx) from DCD was about 2.7% (8/297). Seven KTRs (R1-2, R4, R6-8, R10) associated with rupture of renal artery, occurring on the median 19th (16th-74th) day after KTx respectively, with the rate of rupture of renal artery of 63.6% (7/11), and in R4-5, the thrombus of renal transplant artery was presented on the 43th and 13th day after KTx respectively. Besides, Seven KTRs (R1-2, R4-5, R7-8, R10) underwent excision of transplanted graft on the median 19th(14th-43th) day after the KTx respectively in order to prevention of the further spread of CRKP to the remaining vital organs. Genomic analysis showed there existed two sequence types, ST290 strains and ST11, which fell into two separate clusters, with resistant genes including NDM, KPC and other carbapenemases genes identified. The blaNDM−1 gene was only detected in the ST290 isolates, while the blaKPC−1 gene detected in most isolates. Few SNPs were identified in isolates from donors and recipients.Conclusions: The CRKP positive result of various cultures from DCD donors can contribute to the transmission of infection to the recipients. It is mandatory to perform pre-donation screening for CRKP colonization whether or not the result of culture, not excluding the possibility of false negativity, and, if positive, donation should be contraindicated. The effective infection control strategy was the application of combinational antibiotic scheme including ceftazidime-avibactam plus carbapenem, in conjunction with source control techniques such as allograft nephrectomy and/or thorough debridement.

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Analysis of risk factors associated with healthcare-associated carbapenem-resistant Klebsiella pneumoniae infection in a large general hospital: a case-case-control study

Huang

Qiao

Deng

et al. 2023

Eur J Clin Microbiol Infect Dis

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Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection is a major public health threat in the world. To inform the prevention and control of CRKP infection in hospitals, this study analyzed the factors associated with CRKP infection and resistance to carbapenems in K . pneumoniae . This case-case-control study was carried out in a large general hospital in China from January 2016 to December 2018, comprising 494 hospitalized patients infected with CRKP (case group 1) and 2429 hospitalized patients infected with carbapenem-susceptible K . pneumoniae (CSKP, case group 2). We selected control groups from hospitalized patients without K . pneumoniae infections for the two case groups separately, with a 1:3 case-control ratio, to analyze the risk factors of the two case groups using the conditional logistic regression. Multivariate analysis showed that the risk factors of CRKP infection were intensive care unit (ICU) admission (odds ratio [OR], 6.85; 95% confidence interval [CI], 4.90–9.58; P < 0.001), respiratory failure (OR, 1.93; 95% CI, 1.34–2.77; P < 0.001), age-adjusted Charlson comorbidity index (aCCI; OR, 1.08; 95% CI, 1.02–1.15; P = 0.007), admission from the Emergency (OR, 1.37; 95% CI, 1.02–1.85; P = 0.036), and imipenem use (OR, 1.80; 95% CI, 1.30–2.49; P < 0.001). Among the aforementioned five risk factors, aCCI (OR, 1.09; 95% CI, 1.06–1.13; P < 0.001) was also identified as a risk factor of CSKP infections in multivariate analysis. The risk factors for resistance to carbapenems in K . pneumoniae were ICU admission, respiratory failure, admission from the Emergency, and imipenem use. Supplementary Information The online version contains supplementary material available at 10.1007/s10096-023-04578-w.

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Carbapenem-Resistant Klebsiella Pneumoniae Infections Early After Liver Transplantation: A Single-Center Experience

Cited by 22 publications

References 10 publications

Burden of carbapenem non-susceptible infections in high-risk patients: systematic literature review and meta-analysis

Burden of carbapenem non-susceptible infections in high-risk patients: systematic literature review and meta-analysis

Outcomes of Kidney Transplantation Using Organs From A Donor Infected with Carbapenem-Resistant Klebsiella Pneumoniae in A Chinese Hospital: A Molecular Epidemiological Study

Analysis of risk factors associated with healthcare-associated carbapenem-resistant Klebsiella pneumoniae infection in a large general hospital: a case-case-control study

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