Fatal Donor-Derived Carbapenem-Resistant<i>Klebsiella pneumoniae</i>Infection in a Combined Kidney-Pancreas Transplantation

Varotti, Giovanni; Dodi, Ferdinando; Marchese, Anna; Terulla, Alessia; Bertocchi, M.; Fontana, I.

doi:10.1155/2016/7920951

Cited by 5 publications

(5 citation statements)

References 10 publications

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“…We did not select KT recipients who did not have infections as the control group to facilitate the identification of the factors associated with CRKP infection. In the analysis of the risk factors for CRKP infection, donor-derived infections have been reported as a mechanism of transmission (Mularoni et al, 2015;Varotti et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Analysis of Risk Factors for Carbapenem-Resistant Klebsiella pneumoniae Infection and Its Effect on the Outcome of Early Infection After Kidney Transplantation

Zhang

Zhong

Ding

et al. 2021

Front. Cell. Infect. Microbiol.

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BackgroundInfections remain a major cause of morbidity and mortality in kidney transplant (KT) recipients. This study was performed to identify the overall prevalence of early infections, prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection after KT, one-year postoperative mortality in patients with early infections and risk factors for CRKP infections.MethodsWe conducted a retrospective study of all patients who received KT in our hospital between January 2017 and December 2019. We evaluated the demographic, clinical, infection characteristics and the one-year postoperative outcomes.ResultsAmong the 419 patients who received KT between January 2017 and December 2019, 150 patients had at least one infection within 90 days after KT. The total prevalence of early infections was 36.1% (150/415), the prevalence of early CRKP infections was 10.4% (43/415), and the one-year postoperative mortality was 15.3% (23/150) in patients with early infections. The risk factors independently related to one-year postoperative mortality were mechanical ventilation (MV) > 48 h (Odds ratio (OR)= 13.879, 95%Confidence interval (CI): 2.265~85.035; P=0.004) and CRKP infection (OR=6.751, 95% CI: 1.051~43.369; P =0.044). MV> 48 h was independently related to CRKP infection (OR=3.719, 95% CI: 1.024~13.504; P=0.046). Kaplan-Meier survival curves showed that the one-year survival rate of patients infected with CRKP in the early postoperative stage was significantly lower than that of uninfected patients.ConclusionsIn general, the prevalence of early infections after KT is high, and CRKP infection is closely correlated with poor prognosis. The effective prevention and treatment of CRKP infection is an important way to improve the one-year survival rate after KT.

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Section: Discussionmentioning

confidence: 99%

Analysis of Risk Factors for Carbapenem-Resistant Klebsiella pneumoniae Infection and Its Effect on the Outcome of Early Infection After Kidney Transplantation

Zhang

Zhong

Ding

et al. 2021

Front. Cell. Infect. Microbiol.

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“…A MEDLINE search was conducted using the terms “donor derived,” “donor transmitted,” “donor infection,” and “donor bacteremia” combined with the terms “resistant bacteria,” “ESBL,” “Enterobacteriaceae,” and “transplantation.” We found only one published report of donor‐transmitted ESBL gram‐negative bacterial infection with two clusters of proven transmission from a single infected donor to two recipients . These two clusters, the present case and other donor‐transmitted infections by gram‐negative bacteria, are summarized in Table …”

Section: Literature Reviewmentioning

confidence: 89%

“…9 These two clusters, the present case and other donor-transmitted infections by gram-negative bacteria, are summarized in Table 1. 5,[9][10][11][12][13][14][15][16][17][18] Regarding ESBL gram-negative infection, in 2009, two transplant centers described two kidney transplant recipients with ESBLproducing Escherichia coli urinary tract infection and sepsis, suspected to have been transmitted from the donor. The kidney grafts failed in both recipients, requiring nephrectomy, one had a pseudoaneurysm at the arterial anastomosis and the other pyelonephritis and a perinephric hematoma, but both recipients survived.…”

Section: Literature Reviewmentioning

confidence: 99%

Successful liver transplantation despite donor‐transmitted ESBL‐producing Klebsiella pneumoniae infection: Case report and review of the literature

Escolà-Vergé

Los‐Arcos

González-López

et al. 2017

Transplant Infectious Dis

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Donor-derived bacterial infection is a recognized complication of solid organ transplantation. Patients admitted to the intensive care unit are increasingly exposed to infection with multidrug-resistant microorganisms. However, no specific recommendations are available about their suitability as donors. We report a case of donor-transmitted extended-spectrum beta-lactamase-producing Klebsiella pneumoniae infection in a liver recipient, and review the related literature.

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“…The risk of transmission appears low for donors that have localized CRE infection or colonization of a nontransplanted organ [23,32,35]. The highest risk of transmission is in donors who have CRE bacteremia and infection or colonization of the transplanted organ, such as respiratory tract colonization in a lung donor or gastrointestinal tract colonization in a bowel or pancreas transplant [33]. With the advent of newer and more effective therapies with activity against CRE, as described in subsequent texts, recommendations may become more liberal with regard to accepting such donors.…”

Section: Peri-transplant Management and Donor-derived Cre Infectionsmentioning

confidence: 99%

Carbapenem-Resistant Enterobacteriaceae in Solid Organ Transplantation: Management Principles

Smibert

Satlin

Nellore

et al. 2019

Curr Infect Dis Rep

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Purpose of Review Carbapenem-resistant Enterobacteriaceae (CRE) have emerged as a worldwide problem. Given their degree of immunosuppression and the level of contact with the healthcare system, solid organ transplant (SOT) recipients are at a disproportionately higher risk of acquisition, colonization, and infection with CRE, and outcomes from infection tend to be worse compared to non-transplant patients. Therapeutic options are limited for CRE infections although several newer agents have recently been approved for use. How well these agents perform in the setting of immunosuppression and SOT is unclear. We sought to review the epidemiology of CRE in SOT and the management principles. Recent Findings CRE infections are becoming an increasing problem in SOT, and donor-derived infections present a challenge in the peri-transplant period. Newer treatments for CRE are emerging that are less toxic and potentially more effective than prior CRE-active agents, but supportive clinical data are limited. Newer beta-lactamase inhibitors have good activity against KPC carbapenemases, but they lack activity against metallo-beta-lactamases (e.g., NDM). Promising data is emerging with newer agents that have activity against most carbapenemases, but, again, clinical data is needed. Combination therapy in addition to optimal pharmacokinetic and pharmacodynamics may go some way to improve outcomes against these difficult-to-treat organisms. Other novel therapies that prevent the emergence of resistance (oral beta-lactamase inhibitors) and eradication of resistant Gram-negative colonization (fecal microbiota transplant) may eventually become part of a bundle approach to reduce CRE infections in the future. Summary As in non-transplant patients, CRE infections in the transplant setting are challenging to treat and prevent. Infection prevention and control remains crucial to prevent widespread dissemination, and unique challenges exist with donor-derived CRE and how best to manage recipients in the peri-transplant period. Newer treatments are now in early-phase clinical studies, and in vitro activity data are supportive for several agents providing hope for improved outcomes with these typically difficult-totreat and highly morbid infections in transplant recipients.

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Fatal Donor-Derived Carbapenem-ResistantKlebsiella pneumoniaeInfection in a Combined Kidney-Pancreas Transplantation

Cited by 5 publications

References 10 publications

Analysis of Risk Factors for Carbapenem-Resistant Klebsiella pneumoniae Infection and Its Effect on the Outcome of Early Infection After Kidney Transplantation

Analysis of Risk Factors for Carbapenem-Resistant Klebsiella pneumoniae Infection and Its Effect on the Outcome of Early Infection After Kidney Transplantation

Successful liver transplantation despite donor‐transmitted ESBL‐producing Klebsiella pneumoniae infection: Case report and review of the literature

Carbapenem-Resistant Enterobacteriaceae in Solid Organ Transplantation: Management Principles

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