Carbapenem-Resistant Klebsiella pneumoniae influences the outcome of early infections in liver transplant recipients

Abstract

BackgroundInfections remain a leading cause of morbidity and mortality among liver transplant (LT) recipients. The aim of our study was to define the factors associated with outcome of early bacterial and fungal infections in a cohort of patients who underwent LT at the University Hospital of Ancona over a nine year period.MethodsAll consecutive patients who underwent LT in our center were considered. An early infection was defined as occurring in the first month post-transplantation.ResultsAmong 330 patients who underwent LT from August 2005 to October 2014, 88 (27 %) had at least one infection documented within 30 days after transplantation. In 54 cases only one site was involved, in 34 cases ≥2 sites. There were 43 (30 %) pneumonia, 40 (27 %) surgical site infections, 31 (22 %) blood stream infections, and 30 (21 %) urinary tract infections. Gram-negative bacteria accounted for 64 % of the culture-positive cases, followed by Gram-positive bacteria (30 %) and fungi (6 %). A high proportion of drug-resistant strains was found within either Gram-negative (79 %) or Gram-positive (81 %) bacteria. There were 27 out 88 patients (31 %) who died within 180 days from the transplant. Factors independently associated with a higher risk of mortality were: renal replacement therapy (HR 11.797 [CI95 % 3.082–45.152], p < 0.0001), multisite infections (HR 4.865 [CI95 % 1.417–16.700], p = 0.012) and being infected with carbapenem-resistant Klebsiella pneumoniae (CRKP; HR 5.562 [CI95 % 1.186–26.088], p = 0.030).ConclusionsOverall, these data indicate that early infections in LT patients are characterized by significant mortality. In particular, an early infection caused by CRKP has an adverse impact on survival in these patients suggesting an urgent need for adopting preventive measures to avoiding this complication.

Analysis of Risk Factors for Carbapenem-Resistant Klebsiella pneumoniae Infection and Its Effect on the Outcome of Early Infection After Kidney Transplantation

“…Due to their poor physical function, frequent need for antibacterial treatment, multiple hospitalizations, and immunosuppression, SOT recipients have a higher risk of infection with MDR bacteria (Barchiesi et al, 2016;Pouch and Satlin, 2017). In our study, we investigated the prevalence of early bacterial and fungal infections and the distribution of pathogens after KT.…”

Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia

“…In our study, the type of Enterobacterales was not associated with mortality in the analysis after adjusting by other exposures, as previously observed. 15,21,22 The development of the new INCREMENT-SOT-CPE score was based on the INCREMENT-CPE score, which had been previously validated in the general population in different studies. 9,11,12,23,24 We used this strategy because there are no specific studies in SOT and many transplant groups use this predictive model, which takes into account variables important in any type of patient with BSI, including SOT.…”

“…Clinically significant BSI was defined as the isolation of a carbapenemase-producing Enterobacterales in blood. 15 11,12 and the therapy administered (dates and doses of antibiotics). Empirical therapy was considered appropriate when an active drug was administered before the susceptibility profile.…”

“…Cyclosporine 17 (8) 5 (4) 8 (11) 3 (23) 1 (17 (14) 20 (17) 7 (9) 3 (23) 1 (17 (13) 12 (10) 12 (16) 4 (31) 0 0 -Pneumonia 21 (10) 6 (5) 6 (8) 3 (23) 6 (100) 0 -Skin and soft tissue 5 (2) 0 4 (5) 0 0 1 (50) -Other 16 (7) 15 (13) 1 (1 INCREMENT-CPE score a , median (IQR) 8 (6)(7)(8)(9)(10)(11)(12) 11 (6)(7)(8)(9)(10)(11)(12) 6 (3-11) 13 (7)(8)(9)(10)(11)(12)(13)(14)(15) 11 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)...…”

Infections in Liver Transplantation

“…Mortality associated with CRKP infections in LT recipients ranges from 18% to as high as 80% [172,[174][175][176]. Another cohort of solid organ transplant patients found that infection with CRKP was independently associated with higher mortality (HR 5.562 [CI 95% 1.186-26.088]) [177]. In addition to traditional risk factors associated with CRKP infections in other patient populations, pre-transplant colonization with CRKP can place such patients at an increased risk for CRKP infections following transplantation [175,176].…”