title: Mortality associated with carbapenem-resistant Klebsiella pneumoniae infections in liver transplant recipients.
abstract: Resistant bacterial infections are important causes of morbidity and mortality after liver transplantation (LT). This was a retrospective cohort study evaluating the outcomes associated with carbapenem-resistant Klebsiella pneumoniae (CRKP) infections after LT. In a 2005-2006 cohort of 175 consecutive LT recipients, 91 infection episodes were observed in 61 patients (35%). The mortality rate 1 year after LT was 18% (32/175). Enterococcus (43%) and Klebsiella species (37%) were the most frequently isolated bacteria. CRKP infections occurred in 14 patients, and 10 of these patients (71%) died. Seven of these deaths occurred within 30 days of the CRKP infection. The median time to the onset of CRKP infections was 12 days (range = 1-126 days) after LT. The survival rate was significantly lower for patients with a CRKP infection versus patients without a CRKP infection (29% versus 86%, log-rank P < 0.001). In a multivariate analysis, the only pre-LT and post-LT clinical variables significantly associated with death were a Model for End-Stage Liver Disease score ≥ 30 (hazard ratio = 3.4, P = 0.04) and a post-LT CRKP infection (hazard ratio = 4.9, P = 0.007). In conclusion, the outcomes associated with CRKP infections in LT recipients are poor. Because the optimal treatment strategies for CRKP infections remain undefined, improved preventive strategies are needed to curtail the devastating impact of CRKP in LT recipients.
authors.affiliation: Department of Medicine, Mount Sinai Medical Center, New York, NY 10029, USA.
authors.forename: Jayant S
authors.initials: JS
authors.lastname: Kalpoe
authors.forename: Edith
authors.initials: E
authors.lastname: Sonnenberg
authors.forename: Stephanie H
authors.initials: SH
authors.lastname: Factor
authors.forename: Juan
authors.initials: J
authors.lastname: del Rio Martin
authors.forename: Thomas
authors.initials: T
authors.lastname: Schiano
authors.forename: Gopi
authors.initials: G
authors.lastname: Patel
authors.forename: Shirish
authors.initials: S
authors.lastname: Huprikar
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015780:Carbapenems / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology / Q000401:mortality*; D007711:Klebsiella pneumoniae / Q000472:pathogenicity*; D016031:Liver Transplantation / Q000009:adverse effects / Q000276:immunology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009519:New York City / Q000453:epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems