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Treatment of Donor-derived Carbapenem-resistant Klebsiella pneumoniae Infection after Renal Transplantation with Tigecycline and Extended-infusion Meropenem

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Abstract

Objective

Donor-derived carbapenem-resistant Klebsiella pneumoniae (CRKP) infection has recently emerged as a critical early complication after renal transplantation. Although CRKP is usually sensitive to tigecycline, monotherapy with this drug is often less than effective. We investigated the efficacy of a combined regimen of tigecycline with high-dose, extended-infusion meropenem in the treatment of donor-derived CRKP infection after kidney transplantation.

Methods

From Jan. 2016 to Dec. 2017, a total of 12 CRKP isolates were detected from cultures of the organ preservation solution used for soaking the donor kidneys at our institute. Probable or possible donor-derived infection (DDI) was identified in 8 transplant recipients. Clinical data were retrospectively analyzed.

Results

Klebsiella pneumoniae carbapenemase-2 (KPC-2)-producing CRKP was reported to be positive in organ preservation solution cultures at 3.5±0.9 days after transplantation, leading to surgical site (n=3), urinary tract (n=4), and/or bloodstream (n=2) infections in 8 recipients. The drug susceptibility tests showed that CRKP was sensitive to tigecycline, but resistant to meropenem. In 7 patients who received tigecycline combined with high-dose extended-infusion meropenem, DDIs were successfully cured. The length of hospital stay was 31 (18–129) days, and the serum creatinine at discharge was 105.8±16.7 µmol/L. The one remaining patient who received tigecycline combined with intravenous-drip meropenem died of septic shock. A median follow-up of 43 months (33–55) showed no recurrence of new CRKP infection in the 7 surviving recipients.

Conclusion

It was suggested that a prompt and appropriate combination therapy using tigecycline with high-dose extended-infusion meropenem is effective in treating donor-derived KPC-2-producing CRKP infection after renal transplantation.

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Acknowledgments

We thank Dr. Deborah McClellan for editorial assistance.

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Authors and Affiliations

  1. Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

    Zhi-qiang Wang, Zhi-liang Guo, Hao Feng, Cheng Fu, Guang-yuan Zhao, Lan Zhu & Gang Chen

  2. Department of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

    Ke Ma

  3. Key Laboratory of Organ Transplantation, Ministry of Education, Ministry of Public Health, Chinese Academy of Medical Sciences, Wuhan, 430030, China

    Lan Zhu & Gang Chen

Authors
  1. Zhi-qiang Wang
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  2. Zhi-liang Guo
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  3. Hao Feng
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  4. Cheng Fu
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  5. Guang-yuan Zhao
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  6. Ke Ma
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  7. Lan Zhu
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  8. Gang Chen
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Corresponding authors

Correspondence to Lan Zhu or Gang Chen.

Ethics declarations

All the authors declared no competing interests. The clinical activities being reported are consistent with the principles of the declaration of Istanbul as outlined in the “Declaration of Istanbul on Organ Trafficking and Transplant Tourism”.

Additional information

This project was supported by grants from Non-Profit Central Research Institute Fund of Chinese Academy of Medical Science (No. 2018PT32018) and Hubei Science and Technology Plan (No. 2017ACA096).

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Wang, Zq., Guo, Zl., Feng, H. et al. Treatment of Donor-derived Carbapenem-resistant Klebsiella pneumoniae Infection after Renal Transplantation with Tigecycline and Extended-infusion Meropenem. CURR MED SCI 41, 770–776 (2021). https://doi.org/10.1007/s11596-021-2397-z

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  • DOI: https://doi.org/10.1007/s11596-021-2397-z

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