Colonization of liver transplant recipients with KPC-producing Klebsiella pneumoniae is associated with high infection rates and excess mortality: a case-control analysis

被引:104
作者
Luebbert, C. [1 ]
Becker-Rux, D. [2 ]
Rodloff, A. C. [3 ]
Laudi, S. [2 ]
Busch, T. [2 ]
Bartels, M. [4 ]
Kaisers, U. X. [2 ]
机构
[1] Leipzig Univ Hosp, Dept Gastroenterol & Rheumatol, Div Infect Dis & Trop Med, D-04103 Leipzig, Germany
[2] Leipzig Univ Hosp, Dept Anaesthesiol & Intens Care Med, D-04103 Leipzig, Germany
[3] Leipzig Univ Hosp, Inst Med Microbiol & Epidemiol Infect Dis, D-04103 Leipzig, Germany
[4] Leipzig Univ Hosp, Dept Visceral Transplant Thorac & Vasc Surg, D-04103 Leipzig, Germany
关键词
Klebsiella pneumoniae carbapenemase; KPC-producing Klebsiella pneumoniae; Carbapenem resistance; Liver transplant recipients; Mortality; (KPC)-PRODUCING K. PNEUMONIAE; RISK-FACTORS; EPIDEMIOLOGY; OUTCOMES; THREAT; IMPACT;
D O I
10.1007/s15010-013-0547-3
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Purpose From mid-2010 to early 2013 there was a large single-center (Leipzig University Hospital, Germany) outbreak of Klebsiella pneumoniae carbapenemase (KPC) type 2 producing K pneumoniae (KPC-2-KP) involving a total of 103 patients. The aim of this study was to compare KPC-positive liver transplant recipients (LTR) and KPC-negative controls to determine both the relative risk of infection following colonization with KPC-2-KP and the case fatality rate associated with KPC-2-KP. Methods The study cohort of this retrospective observational study comprised nine patients who had undergone orthotopic liver transplantation (LTx) (median age of 52 years, range 28-73 years) with confirmed evidence of colonization with KPC-2-KP. The data from these nine LTR were matched to 18 LTR (1:2) in whom carbapenem-resistant pathogens were not present and compared for clinical outcomes. Results Of these nine cases, eight (89 %) progressed to infection due to KPC-2-KP, and five (56 %) were confirmed to have bloodstream infection with KPC-2-KP. Matched-pair analysis of KPC-positive LTR and KPC-negative controls revealed a substantially increased relative risk of 7.0 (95 % confidence interval 1.8-27.1) for fatal infection with KPC-2-producing K pneumoniae after transplantation with a mortality rate of 78 % (vs. 11 %, p = 0.001). Conclusions Colonization with KPC-2-KP in LTR leads to high infection rates and excess mortality. Therefore, frequent screening for carbapenem-resistant bacteria in patients on LTx waiting lists appears to be mandatory in an outbreak setting. Patients with evidence of persistent colonization with KPC-producing pathogens should be evaluated with extreme caution for LTx.
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页码:309 / 316
页数:8
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