Impact of carbapenem‐resistant Klebsiella pneumoniae (CR‐KP) infections in kidney transplantation

Abstract

The study confirmed that a CR-KP positivity may affect the outcome of a kidney transplant population. In severe CR-KP infections with sepsis, a combined antibiotic treatment seems to be advisable.

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

“…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].…”

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

“…The risk of CRE infection following SOT depends on geography, occurrence of local outbreaks, patterns of resistance, and the organ transplanted. The risk is documented to range from 0.4 to 26.3%, but the majority of data is limited to single-center studies analyzing abdominal organ transplant recipients (Table 2) [22,[34][35][36][37][38][39][40][41][42][43][44][45]. In the USA, the incidence of CRE infection posttransplant is less than 10% [35-37, 42, 43], but in Brazil the risk can be as high as 26% in renal transplant patients [34].…”

“…However, a national surveillance program in Italy reported that 26.5% of all Gram-negative isolates from SOT recipients were carbapenem resistant [46]. Most CRE infections occur within the first 3 months after transplant, but the median or mean time from transplant to infection ranges from 11 to 218 days [22,[34][35][36][37][38][39][40][41][42][43][44][45]47].…”

“…Risk factors include hepatitis C virus, hepatocellular carcinoma, higher MELD score, Roux-en-Y choledochojejunostomy, bile leak, renal replacement therapy and mechanical ventilation for greater than 48 h after transplant, pretransplant colonization with CRE, combined organ transplant, and need for reoperation after transplant (Table 3) [37][38][39]47]. In renal transplant patients, UTIs are the most common source of CRE infection, with secondary bacteremia frequently observed [34,[40][41][42][43][44][45]. Central venous catheters have also been implicated in CRE infections, and in one study including heart, liver, and kidney transplant recipients, 75% of the primary bloodstream infections were catheter-related [34].…”

“…CRE infections portend an increased risk of morbidity and mortality among SOT recipients [22,36,37,42,45,47]. The 30-day mortality rate among SOT recipients with CRE infections ranges from 0 to 50% and can approach 75% at 1-year (Table 2) [22,[34][35][36][37][38][39][40][41][42][43][44][45]47].…”