Colonization of liver transplant recipients with KPC-producing Klebsiella pneumoniae is associated with high infection rates and excess mortality: a case–control analysis
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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.
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.
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).
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.
KeywordsKlebsiella pneumoniae carbapenemase KPC-producing Klebsiella pneumoniae Carbapenem resistance Liver transplant recipients Mortality
The authors would like to thank Joachim Mössner, MD, PhD (Professor and Chair, Department of Gastroenterology and Rheumatology) and Wolfgang Fleig, MD, PhD (Professor of Medicine, Medical Chairman and Chairman of the Board), both Leipzig University Hospital, Germany, for their assistance.
Conflict of interest
All authors deny any potential conflicts of interest, including relevant financial interests, activities, relationships, and affiliations (other than those affiliations listed in the title page) relevant to the subject of this manuscript.
- 8.Kaase M. Zur aktuellen Situation bei Carbapenemase-bildenden gramnegativen Bakterien in Deutschland. Epid Bull. 2013;19:167–71.Google Scholar
- 9.Mouloudi E, Protonotariou E, Zagorianou A, Iosifidis E, Karapanagiotou A, Giasnetsova T, et al. Bloodstream infections caused by metallo-b-lactamase/Klebsiella pneumonia carbapenemase-producing K. pneumoniae among intensive care unit patients in Greece: risk factors for infection and impact of type of resistance on outcomes. Infect Control Hosp Epidemiol. 2010;31:1250–6.PubMedCrossRefGoogle Scholar
- 12.Saidel-Odes L, Polachek H, Peled N, Riesenberg K, Schlaeffer F, Trabelsi Y, et al. A randomized, double-blind, placebo-controlled trial of selective digestive decontamination using oral gentamicin and oral polymyxin E for eradication of carbapenem-resistant Klebsiella pneumoniae carriage. Infect Control Hosp Epidemiol. 2012;33:14–9.PubMedCrossRefGoogle Scholar
- 16.Lübbert C, Faucheux S, Becker-Rux D, Laudi S, Dürrbeck A, Busch T, et al. Rapid emergence of secondary resistance to gentamicin and colistin following selective digestive decontamination in patients with KPC-2-producing Klebsiella pneumoniae: a single-centre experience. Int J Antimicrob Agents. 2013. doi: 10.1016/j.ijantimicag.2013.08.008. Accessed 12 Oct 2013.PubMedGoogle Scholar
- 19.European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint tables for interpretation of MICs and zone diameters. Version 2.0. 2012. Available at: http://www.eucast.org. Accessed 12 Oct 2013.
- 20.ISO (International Organization for Standardization). Clinical laboratory testing and in vitro diagnostic test systems––susceptibility testing of infectious agents and evaluation of performance of antimicrobial susceptibility test devices-part 1. Reference method for testing the in vitro activity of antimicrobial agents against rapidly growing aerobic bacteria involved in infectious diseases. 2010. Available at: http://www.iso.org. Accessed 12 Oct 2013.