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

医学 内科学 肾移植 肌酐 单变量分析 肺炎克雷伯菌 移植 败血症 肾功能 胃肠病学 回顾性队列研究 抗生素 人口 菌血症 多元分析 微生物学 化学 大肠杆菌 基因 环境卫生 生物 生物化学
作者
Giovanni Varotti,Ferdinando Dodi,Alessia Terulla,Gregorio Santori,Gabriele Mariottini,M. Bertocchi,Anna Marchese,I. Fontana
出处
期刊:Transplant Infectious Disease [Wiley]
卷期号:19 (6) 被引量:20
标识
DOI:10.1111/tid.12757
摘要

Carbapenem-resistant Klebsiella pneumoniae (CR-KP) infections in solid organ transplant patients are progressively increasing and are associated with worse outcomes, although potential risk factors and therapeutic strategies are still not well defined.We conducted a retrospective matched-pair analysis in which we compared 26 recipients CR-KP-positive after kidney transplantation (KT) with 52 CR-KP-negative patients transplanted in the same period, during a CR-KP outbreak that occurred in our hospital. Twenty-one patients (80%) received a combined antibiotic treatment. At the end of the follow-up, of the 26 CR-KP infected patients, 11 (42.3%) experienced at least one episode of re-infection, 9 (34.6%) remained colonized, and 6 (23.0%) had a symptomatic infection. Two of the 11 patients with re-infection died, while 9 were colonized at the end of the study.A significantly better patient (P = .043) and graft (P < .001) survival was observed in CR-KP-negative patients. Univariate analysis identified the following variables as potential risk factors associated with CR-KP infection after KT: lower body mass index (P = .020); higher creatinine levels at post-transplant days 7 (P = .009), 15 (P = .026), and 30 (P = .019); longer hospital stay (P = .007); longer cold ischemia time (P = .004); delayed graft function (P = .020); and higher Clavien-Dindo score (P = .006).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.
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