Fatal cross infection by carbapenem‐resistant Klebsiella in two liver transplant recipients

Abstract

Members of the family Enterobacteriaceae including Klebsiella have re-emerged as major pathogens in solid organ transplantation. The recent appearance and dissemination of carbapenemase-producing Enterobacteriaceae in Europe and the northeastern United States represents a major challenge to the treatment of enteric gram-negative bacterial infections in immunocompromised patients; however, few reports have detailed the outcomes of such infections. Here we report two cases of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella infections in orthotopic liver transplant recipients, which were the index case and initial secondary case for an outbreak of KPC-producing Enterobacteriaceae in our institution. In both instances, the pathogens were initially misidentified as being carbapenem sensitive, the infections recurred after cessation of directed therapy, and the patients ultimately succumbed to their infections.

Carbapenem-resistant Enterobacteriaceae in special populations: Solid organ transplant recipients, stem cell transplant recipients, and patients with hematologic malignancies

“…Furthermore, CRE infections in liver transplant recipients have been reported as the index cases of CRE in hospital outbreaks. 32,87 In 2012, the Centers for Disease Control and Prevention (CDC) published a toolkit providing guidance on the prevention of CRE in healthcare facilities. Updated recommendations in November 2015 included optimizing compliance with hand hygiene and contact precautions, healthcare personnel education, minimizing the use of indwelling devices such as central venous catheters, endotracheal tubes, and urinary catheters, antimicrobial stewardship, environmental cleaning, patient and staff cohorting, screening contacts of CRE patients, active surveillance, and chlorhexidine bathing.…”

“…Reported mortality rates among SOT recipients with CRE infection generally range from 30-50%, and post-transplant CRKP infections have been associated with as much as a 10-fold risk of death. [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] However, a more recent cohort of 164 SOT recipients across 15 international sites confirmed that while CRE infection typically occurs in the early post-transplant period, the one-year survival rate of patients who developed CRE infection within the first year of transplant was 72%. 34 While CRKP infections remain the most common type of CRE infection in SOT recipients, infections due to carbapenem-resistant Enterobacter spp., as well as NDM-and OXA-48-producing K. pneumoniae have also been reported.…”

“…19 The incidence of post-SOT CRKP infection varies considerably by center and type of transplant (Table 1). [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] In general, CRKP infections occur early after transplant, with most studies reporting a median time of <50 days from transplant to infection. Reported mortality rates among SOT recipients with CRE infection generally range from 30-50%, and post-transplant CRKP infections have been associated with as much as a 10-fold risk of death.…”

Carbapenem-resistantKlebsiella pneumoniaecolonization at liver transplantation: A management challenge

“…[1][2][3][4] Hence, different preventive strategies for patients who are colonized with CR-KP have been advocated, and they vary from selective intestinal decontamination to the avoidance of transplantation. However, literature data on the real incidence and timing of invasive infections with CR-KP among colonized patients undergoing LT are limited and confusing.…”

The KPC type beta-lactamases: new enzymes that confer resistance to carbapenems in Gram-negative bacilli.

“…Infections due to bacteria producing KPC carbapenemases often have been associated with high mortality in affected patients [31,34,68].…”