Risk Factors for Infection With Carbapenem-Resistant Klebsiella pneumoniae

Abstract

Improved understanding of risk factors associated with carbapenem-resistant-Klebsiella pneumoniae (CR-KP) infection after liver transplantation (LT) can aid development of effective preventive strategies. We performed a prospective cohort study of all adult patients undergoing LT at our hospital during 30-month period to define risk factors associated with CR-KP infection. All patients were screened for CR-KP carriage by rectal swabs before and after LT. No therapy was administered to decolonize or treat asymptomatic CR-KP carriers. All patients were monitored up to 180 days after LT. Of 237 transplant patients screened, 41 were identified as CR-KP carriers (11 at LT, 30 after LT), and 20 developed CR-KP infection (18 bloodstream-infection, 2 pneumonia) a median of 41.5 days after LT. CR-KP infection rates among patients non-colonized, colonized at LT, and colonized after LT were 2%, 18.2% and 46.7% (p < 0.001). Independent risk factors for CR-KP infection identified by multivariate analysis, included: renal-replacement-therapy; mechanical ventilation > 48 h; HCV recurrence, and colonization at any time with CR-KP. Based on these four variables, we developed a risk score that effectively discriminated patients at low versus higher risk for CR-KP infection (AUC 0.93, 95% CI 0.86-1.00, p < 0.001). Our results may help to design preventive strategies for LT recipients in CR-KP endemic areas.

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

“…In the case of liver transplant recipients, data from Giannella et al suggest that gastrointestinal surveillance should continue after the transplant. 95 Further studies are needed to validate the above findings and assess the role of screening for CRE in other types of SOT recipients and patients with hematologic malignancies who do not undergo HSCT.…”

“…The authors proposed a scoring system that consisted of the need for renal replacement therapy, >48 hours of mechanical ventilation, histological recurrence of hepatitis C virus, and CRKP rectal carriage at any time, to discriminate patients at low versus higher risk for CRKP infection following liver transplant. 95 In a nationwide study of Italian HSCT centers, over 5,000 patients were screened for colonization with CRKP prior to transplantation. 64 Of these, 1% of autologous and 2.4% of allogeneic HSCT recipients were colonized with CRKP prior to their transplant.…”

Aquisição de bactéria gram-negativa multidroga resistente antes do transplante de fígado: o impacto no desfecho

“…(59) In our study, pre-LT acquisition was also the only risk factor identified for developing CRE infection.…”

“…(70) (59) One possible explanation for that finding is that bla KPCproducing CRKP are described as more virulent than the strains that harbor other types of carbapenem resistance mechanisms and in this cohort the majority of CRE were bla KPC negative. (85) There have been few studies analyzing the risk of CRE acquisition and infection in Liver transplant patients in a context of weekly screening.…”

Severe Bloodstream Infection due to KPC-Producer E coli in a Renal Transplant Recipient Treated With the Double-Carbapenem Regimen and Analysis of In Vitro Synergy Testing

“…18 Subjects could become colonized or infected with MDR microorganisms before or after transplantation. 19 …”