Infection with Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae in solid organ transplantation
: Klebsiella pneumoniae carbapenemase (KPC)‐producing K. pneumoniae is spreading globally and represents a challenge in infection control and treatment. Solid organ transplant (SOT) recipients are especially at risk for infection by multidrug‐resistant bacteria, and little is known about infection w...
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Veröffentlicht in: | Transplant infectious disease 2012-04, Vol.14 (2), p.198-205 |
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Klebsiella pneumoniae carbapenemase (KPC)‐producing K. pneumoniae is spreading globally and represents a challenge in infection control and treatment. Solid organ transplant (SOT) recipients are especially at risk for infection by multidrug‐resistant bacteria, and little is known about infection with KPC‐producing organisms in this setting. The aim of this study was to describe the clinical and microbiologic aspects of KPC‐producing K. pneumoniae infections in SOT recipients. A KPC‐2‐producing K. pneumoniae outbreak was identified in a public teaching tertiary care hospital in São Paulo, Brazil, in June 2009. During the outbreak, cases of KPC‐2‐producing K. pneumoniae infection in SOT recipients occurred between July 2009 and February 2010; these cases were retrospectively reviewed. Overall, 12 episodes of infection with KPC‐producing K. pneumoniae occurred in 2 heart, 4 liver, and 6 kidney transplant recipients with incidence rates of 16.7%, 12.9%, and 26.3% in heart, liver, and kidney transplantation, respectively. Infection occurred at a median time of 20 days after transplantation. Primary infection sites were as follows: 4 urinary tract infections, 4 bloodstream infections, 2 pneumonias, and 2 surgical site infections. All patients except one had received antibiotics in the last 30 days, mostly piperacillin‐tazobactam or glycopeptides. All strains exhibited susceptibility to amikacin and gentamicin. Patients were treated with tigecycline plus polymyxin B (3 cases), polymyxin B plus carbapenem (3 cases), polymyxin B alone (3 cases), or tigecycline plus imipenem (1 case). In 2 cases, patients received only carbapenem, and death occurred before the final culture result. The overall 30‐day mortality rate was 42%. In this series of KPC‐producing K. pneumoniae infection in SOT recipients, the infection occurrence was high during an institutional outbreak and was potentially life threatening. |
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ISSN: | 1398-2273 1399-3062 |
DOI: | 10.1111/j.1399-3062.2011.00688.x |