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Erschienen in: Infection 3/2015

01.06.2015 | Original Paper

Risk factors and outcome of infections with Klebsiella pneumoniae carbapenemase-producing K. pneumoniae in kidney transplant recipients

verfasst von: Maristela P. Freire, Edson Abdala, Maria L. Moura, Flávio Jota de Paula, Fernanda Spadão, Hélio H. Caiaffa-Filho, Elias David-Neto, William C. Nahas, Ligia C. Pierrotti

Erschienen in: Infection | Ausgabe 3/2015

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Abstract

Introduction

Solid organ transplant recipients are especially susceptible to healthcare-associated infections with Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp-HAIs). The aim of the study was to evaluate risk factors and outcome of these infections in kidney transplant recipients.

Methods

This was a retrospective cohort of kidney transplant (KTx) recipients between January 2009 and December 2013. Cases were defined as patients who developed KPC-Kp-HAI, confirmed by PCR for bla KPC gene after KTx during the study period. We analysed variables related to recipient; induction immunosuppressant therapy; delayed graft function; use of invasive devices; SOFA score on the first day of infection; type of therapy; time from positive culture to appropriate antimicrobial therapy; bacteraemia; and concomitant infection. Outcome measures were the occurrence of KPC-Kp-HAI and 30-day mortality after KPC-Kp-HAI.

Results

A total of 1,101 were submitted to KTx in the period, 21 patients were classified as infected with KPC-Kp. Another ten patients had KPC-Kp-HAI in the period and were transplanted before 2009. Of those 31 patients, 48.4 % showed evidence of prior colonization and 38.7 % had bacteraemia. The most common site of infection was the surgical wound. Risk factors for KPC-Kp-HAI were multi-organ transplantation and the use of a ureteral stent. Eight of the infected patients experienced recurrence of the infection. The 30-day mortality rate was 41.9 %. Survival was significantly lower among the patients with KPC-Kp-HAI (72 vs. 89.1 %; P = 0.002). The only risk factor independently associated with 30-day mortality was an elevated SOFA score on the first day of infection.

Conclusions

In KTx recipients, the occurrence of KPC-Kp-HAI was related to invasive devices and type of transplant; these infections had a high rate of recurrence and reduced survival after KTx.
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Metadaten
Titel
Risk factors and outcome of infections with Klebsiella pneumoniae carbapenemase-producing K. pneumoniae in kidney transplant recipients
verfasst von
Maristela P. Freire
Edson Abdala
Maria L. Moura
Flávio Jota de Paula
Fernanda Spadão
Hélio H. Caiaffa-Filho
Elias David-Neto
William C. Nahas
Ligia C. Pierrotti
Publikationsdatum
01.06.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Infection / Ausgabe 3/2015
Print ISSN: 0300-8126
Elektronische ISSN: 1439-0973
DOI
https://doi.org/10.1007/s15010-015-0743-4

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