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

Abstract

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.

Survival of Carbapenem-Resistant Klebsiella pneumoniae Sequence Type 258 in Human Blood

“…2D). The finding that these K. pneumoniae clinical isolates were susceptible to components in NHS is intriguing, because ST258 is well-known to cause fatal bacteremia, albeit in individuals with significant comorbidities, such as immunosuppression (14)(15)(16)(17)(18)(19)(20).…”

“…Carbapenem-resistant K. pneumoniae infections are often associated with bacteremia. The rate of mortality among these patients is high (ϳ50%), primarily because of patient comorbidities and limited treatment options (7,(14)(15)(16)(17)(18)(19)(20)(21)(22). In the …”

“…In addition, carbapenem-resistant K. pneumoniae strains have spread globally and are highly prevalent in Israel, Greece, Italy, China, and South America (10)(11)(12)(13). Infections with MDR K. pneumoniae strains are associated with high rates of morbidity and mortality, particularly among persons with prolonged hospitalization, critically ill patients, and individuals with invasive devices (7,(14)(15)(16)(17)(18)(19)(20)(21)(22). The expanded drug resistance profile of K. pneumoniae KPC strains has severely limited the treatment options available following infection (23,24).…”

Infections due to multidrug‐resistant organisms following heart transplantation: Epidemiology, microbiology, and outcomes

“…Solid organ transplantation has been described as a risk factor for MDRO infections and is associated with increased mortality in comparison with non‐MDRO infections . The majority of published literature pertains to abdominal organ transplantation and is focused primarily on infections due to carbapenem‐resistant Klebsiella pneumoniae (CRKP) . While thoracic SOT recipients have been found to be at risk for MDRO infections, data specific to heart transplantation are limited.…”

Does the urinary tract infection caused by carbapenem‐resistant Gram‐negative bacilli impact the outcome of kidney transplant recipients?

“…Although the mortality rate of CRE infection among SOT recipients is higher than in the general population, ranging between 28% and 68%, in a multicentric study among SOT recipients with CRE infection, UTI seems to be related to low mortality rates when compared with other types of infections. Therefore, the impact of UTI caused by CRE in the survival of grafts and KT recipients is not known …”