Infections With blaKPC-2-Producing Klebsiella pneumoniae in Renal Transplant Patients: A Retrospective Study

Cicora, Federico; Mos, Fernando; Paz, Marta; Allende, Natalia; Roberti, Javier

doi:10.1016/j.transproceed.2013.07.064

Cited by 33 publications

(39 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In Brazil, Argentina, and Israel, 12 OTRs with UTIs due to CRKP have been described, 6 (50%) of whom were bacteremic (17)(18)(19). Mortality rates ranged from 0 to 33%.…”

Section: Discussionmentioning

confidence: 99%

Carbapenem-Resistant Klebsiella pneumoniae Urinary Tract Infection following Solid Organ Transplantation

Brizendine

Richter

Cober

et al. 2015

Antimicrob Agents Chemother

View full text Add to dashboard Cite

c Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an emerging pathogen with a devastating impact on organ transplant recipients (OTRs). Data describing urinary tract infections (UTIs) due to CRKP, compared to extended-spectrum ␤-lactamase (ESBL)-producing and susceptible K. pneumoniae, are lacking. We conducted a retrospective cohort study comparing OTRs with a first episode of UTI due to CRKP, ESBL-producing K. pneumoniae, or susceptible K. pneumoniae. We identified 108 individuals; 22 (20%) had UTIs due to CRKP, 22 (20%) due to ESBL-producing K. pneumoniae, and 64 (60%) due to susceptible K. pneumoniae. Compared to susceptible K. pneumoniae (27%), patients with UTIs due to CRKP or ESBL-producing K. pneumoniae were more likely to have a >24-hour stay in the intensive care unit (ICU) before or after development of the UTI (64% and 77%, respectively; P < 0.001). Among 105/108 hospitalized patients (97%), the median lengths of stay prior to UTI with CRKP or ESBL-producing K. pneumoniae (7 and 8 days, respectively) were significantly longer than that for susceptible K. pneumoniae (1 day; P < 0.001). Clinical failure was observed for 8 patients (36%) with CRKP, 4 (18%) with ESBL-producing K. pneumoniae, and 9 (14%) with susceptible K. pneumoniae (P ‫؍‬ 0.073). Microbiological failure was seen for 10 patients (45%) with CRKP, compared with 2 (9%) with ESBL-producing K. pneumoniae and 2 (3%) with susceptible K. pneumoniae (P < 0.001). In multivariable logistic regression analyses, CRKP was associated with greater odds of microbiological failure (versus ESBL-producing K. pneumoniae: odds ratio [OR], 9.36, 95% confidence interval [CI], 1.94 to 72.1; versus susceptible K. pneumoniae: OR, 31.4, 95% CI, 5.91 to 264). In conclusion, CRKP is associated with ICU admission, long length of stay, and microbiological failure among OTRs with UTIs. Greater numbers are needed to determine risk factors for infection and differences in meaningful endpoints associated with carbapenem resistance.

show abstract

“…In Brazil, Argentina, and Israel, 12 OTRs with UTIs due to CRKP have been described, 6 (50%) of whom were bacteremic (17)(18)(19). Mortality rates ranged from 0 to 33%.…”

Section: Discussionmentioning

confidence: 99%

Carbapenem-Resistant Klebsiella pneumoniae Urinary Tract Infection following Solid Organ Transplantation

Brizendine

Richter

Cober

et al. 2015

Antimicrob Agents Chemother

View full text Add to dashboard Cite

show abstract

“…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.…”

mentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

“…Most of these infections are CRKP urinary tract infections (UTIs), with secondary bacteremia present in up to 32% of patients. 20,[26][27][28]30,33 CRKP UTIs are associated with high rates of microbiological failure compared to carbapenem-susceptible K. pneumoniae UTIs, and the presence of post-transplant CRKP bacteriuria has been independently associated with a 3-fold risk of death in kidney transplant recipients. 27,33 To date, 7 cases of CRKP donor-derived infection have been reported.…”

mentioning

confidence: 99%

See 1 more Smart Citation

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

2016

View full text Add to dashboard Cite

Carbapenem-resistant Enterobacteriaceae (CRE) are a major global public health concern and pose a serious threat to immunocompromised hosts, particularly patients with hematologic malignancies and solid organ (SOT) and stem cell transplant recipients. In endemic areas, carbapenem-resistant Klebsiella pneumoniae infections occur in 1-18% of SOT recipients, and patients with hematologic malignancies represent 16-24% of all patients with CRE bacteremia. Mortality rates approaching 60% have been reported in these patient populations. Early diagnosis and rapid initiation of targeted therapy is critical in the management of immunocompromised hosts with CRE infections, as recommended empiric regimens are not active against CRE. Therapeutic options are limited by antibiotic-associated toxicities, interactions with immunosuppressive agents, and paucity of antibiotic options currently available. Prevention of CRE infection in these patients requires a multidisciplinary approach involving hospital epidemiology and antimicrobial stewardship. Large, multicenter studies are needed to develop risk-stratification tools to assist in guiding the management of these individuals.

show abstract

“…7 The limited amount of clinical data currently prevents definite conclusions on the eligibility of patients with end-stage liver disease and persistent CRKP carriage for transplantation. 10 Nevertheless, we propose that specifically in a CRKP outbreak situation (which implies a high risk of progression to fatal infection), these patients should not be considered for LT. 3 Thilo Busch, Ph.D. 3 Joachim M€ ossner, M.D., Ph.D. 4 Michael Bartels, M.D., Ph.D. 5 Udo X. Kaisers, M.D., Ph. The data are presented as means and standard deviations.…”

mentioning

confidence: 99%

Lessons learned from excess mortality associated withKlebsiella pneumoniaecarbapenemase 2-producingk. pneumoniaein liver transplant recipients

et al. 2014

View full text Add to dashboard Cite

Infections With blaKPC-2-Producing Klebsiella pneumoniae in Renal Transplant Patients: A Retrospective Study

Cited by 33 publications

References 22 publications

Carbapenem-Resistant Klebsiella pneumoniae Urinary Tract Infection following Solid Organ Transplantation

Carbapenem-Resistant Klebsiella pneumoniae Urinary Tract Infection following Solid Organ Transplantation

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

Lessons learned from excess mortality associated withKlebsiella pneumoniaecarbapenemase 2-producingk. pneumoniaein liver transplant recipients

Contact Info

Product

Resources

About