Effect of Carbapenem-Resistant Klebsiella pneumoniae Infection on the Clinical Outcomes of Kidney Transplant Recipients

Abstract

Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection has proven to be difficult to control and typically presents with devastating effects. Methods: This retrospective study was conducted on the renal recipients at our institution between January 2021 to January 2022. Clinical data was collected to identify factors associated with CRKP infection and clinical outcomes. Results: There were 104 cases out of 186 total renal recipients who presented with at least one infection within 3 months after KT, and 14 cases developed unfavorable clinical outcomes. We identified 16 confirmed CRKP infected cases with the incidence of 8.60%. Possible donor derived infection (DDI) (OR = 6.743; 95% CI: 1.477-30.786; P = 0.014) were independent risk factors for the occurrence of CRKP infection of renal recipients in our analysis, CRKP infection (OR = 20.723; 95% CI: 3.448-124.547; P = 0.001) and pneumonia (OR = 28.458; 95% CI: 1.956-413.984 P = 0.014) were independent risk factors for the occurrence of unfavorable clinical outcomes following KT, and the occurrence of unfavorable clinical outcomes following KT were significantly associated with CRKP infection (r = 0.535; P < 0.001) and antibiotic regimen containing ceftazidime/avibactam (CZA) (r = −0.655; P = 0.006). The use of CZA was significantly different in the comparison of antibiotic regimens between the CRKP infected renal recipients with unfavorable outcomes and CRKP infected patients with favorable outcomes. Conclusion: It is possible that DDI can lead to CRKP infection, and CRKP infection and pneumonia were closely correlated with poor prognosis. The use of CZA may play a role in avoiding the unfavorable outcomes of CRKP infected recipients.

Burden and Management of Multi-Drug Resistant Organism Infections in Solid Organ Transplant Recipients Across the World: A Narrative Review

“…Risk factors for CRE infection have been usually investigated in specific organ transplant settings and most commonly in OLT recipients (see Table 2 ) [ 48 , 75 , 79 , 80 ]. Carriage, either acquired before or after transplant, and peri-surgical complications have been associated with highest risk of developing CRE infection [ 48 , 77 ].…”

“…Usually, CRE infection occurs in the first 4-8 weeks after transplant, earlier infections (within 2 weeks) are observed in pre-transplant carriers and/or in donor derived infections (DDI) [48,53,92]. Notably, incidence of DDI due to CRE is high in China, one study focused on KT patients reported that possible DDI increased the risk of CRE infection by more than six times [75]. Authors reported varying prevalence rates of CRE among donor or preservation fluid cultures, ranging from 1.6% to 19.2% [93][94][95].…”