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

Lübbert, D.T.M.H. Christoph; Rodloff, Arne C.; Laudi, Sven; Simon, Philipp; Busch, Thilo; Mössner, Joachim; Bartels, Michael; Kaisers, Udo X.

doi:10.1002/lt.23858

Cited by 20 publications

(5 citation statements)

References 9 publications

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“…Firstly, CRE infections tend to attack the most vulnerable LT patients, who had worse underlying conditions, went through complicated surgical procedures or suffered from surgical or medical complications. [3][4][5][6]12 In our center, CRE infections tend to occur in patients with worse pre-or post-LT conditions, high MELD score, high intraoperative blood loss, reoperation, biliary complications, vascular complications, prolonged ventilation time or prolonged renal replacement therapy, as shown in Table 1. Secondly, identification of CRE from clinical specimens can take up to 2-3 days; therefore, the administration of appropriate therapy can be delayed.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Outcomes of Carbapenem-Resistant Enterobacteriaceae Infection After Liver Transplantation: A Retrospective Study in a Chinese Population

Chen¹,

Wang²,

Zhang³

et al. 2020

IDR

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Background There is an increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE) infection after liver transplantation (LT). Improved understanding of the risk factors and outcomes of CRE infections can help us to develop effective preventive strategies and even guide early treatment of high-risk LT patients. Methods This was a retrospective study involving all Chinese adult patients who underwent LT between December 2017 and September 2019 in our center. We analyzed the possible risk factors and outcomes associated with CRE infections in the first 30 days post-LT. Results A total of 387 patients underwent LT. Among them, 26 patients (6.7%) developed CRE infections within 30 days after transplantation. Patients with CRE infections had significantly lower 30-day and 180-day survival rates (80.8% vs 96.4%, p <0.001; 51.5% vs 92.4%, p <0.001). Multivariate analysis identified that intraoperative blood loss equal to or more than 1500 mL (odds ratio [OR], 3.666; 95% confidence interval [CI], 1.407–9.550; p =0.008), CRE rectal carriage within 30 days post-LT (OR, 5.516; 95% CI, 2.113–14.399; p =0.000), biliary complications (OR, 3.779; 95% CI, 1.033–13.831; p =0.045) and renal replacement therapy for more than 3 days (OR, 3.762; 95% CI, 1.196–11.833; p =0.023) were independent risk factors for CRE infections within 30 days post-LT. Conclusion CRE infections within 30 days post-LT were associated with worse outcomes. Intraoperative blood loss equal to or more than 1500 mL, CRE rectal carriage within 30 days post-LT, biliary complications and renal replacement therapy for more than 3 days were independent risk factors of CRE infections after LT.

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Section: Discussionmentioning

confidence: 99%

Risk Factors and Outcomes of Carbapenem-Resistant Enterobacteriaceae Infection After Liver Transplantation: A Retrospective Study in a Chinese Population

Chen¹,

Wang²,

Zhang³

et al. 2020

IDR

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“…Another well-known early complication is pneumonia, which has an incidence rate of 7-46% [32]. It is linked to increased length of stay and mortality, especially when multidrug resistant pathogens are isolated [33][34][35].…”

Section: Other Infections Related To Health Carementioning

confidence: 99%

Infectious Complications After A Liver Transplant

Michailidou¹,

Katsanos²,

Antoniadis³

et al. 2023

Sur Res J

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Liver transplantation is a life-extending procedure for patients with end-stage liver disease (ESLD), post-transplant infections continue to be a leading cause of morbidity and mortality. Infection risk varies over time, with issues most commonly related to transplant surgery and nosocomial infections in the early post-transplant period. Because of the increased burden of immunosuppression, opportunistic infections become more common between 1 and 12 months post-transplant. As immunosuppression is reduced after 12 months, the risk of opportunistic infections decreases. Recipients are still vulnerable to community-acquired infections, and recurrent cholangitis may become an issue in those with chronic allograft dysfunction or recurrent cholestatic liver disease. This article will go over a strategy for dealing with infectious complications in the early, intermediate, and late stages following liver transplantation, with a focus on the most common infections as well as those of emerging concern

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“…Carbapenemases hydrolyse penicillins, all cephalosporins, beta-lactamase inhibitors, and even carbapenems. The most widespread carbapenemases are Klebsiella pneumoniae carbapenemases [ 52 , 53 , 54 , 55 ]. These are rapidly emerging as an important source of hospital-acquired infections in many regions of the world.…”

Section: Presumed Pathogens Involved and Individual Patient Risk Fact...mentioning

confidence: 99%

A Proposal for a Classification Guiding the Selection of Appropriate Antibiotic Therapy for Intra-Abdominal Infections

Sartelli

Cristini²,

Coccolini³

et al. 2022

Antibiotics

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Adequately controlling the source of infection and prescribing appropriately antibiotic therapy are the cornerstones of the management of patients with intra-abdominal infections (IAIs). Correctly classifying patients with IAIs is crucial to assessing the severity of their clinical condition and deciding the strategy of the treatment, including a correct empiric antibiotic therapy. Best practices in prescribing antibiotics may impact patient outcomes and the cost of treatment, as well as the risk of “opportunistic” infections such as Clostridioides difficile infection and the development and spread of antimicrobial resistance. This review aims to identify a correct classification of IAIs, guiding clinicians in the selection of the best antibiotic therapy in patients with IAIs.

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

Cited by 20 publications

References 9 publications

<p>Risk Factors and Outcomes of Carbapenem-Resistant Enterobacteriaceae Infection After Liver Transplantation: A Retrospective Study in a Chinese Population</p>

<p>Risk Factors and Outcomes of Carbapenem-Resistant Enterobacteriaceae Infection After Liver Transplantation: A Retrospective Study in a Chinese Population</p>

Infectious Complications After A Liver Transplant

A Proposal for a Classification Guiding the Selection of Appropriate Antibiotic Therapy for Intra-Abdominal Infections

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