title: Carbapenem-resistant Klebsiella pneumoniae infections in kidney transplant recipients: a case-control study.
abstract: BACKGROUND
  Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections have emerged as a significant challenge in solid organ transplantation. CRKP infections in other patient populations have been associated with higher mortality, when compared to infections caused by carbapenem-sensitive K. pneumoniae (CSKP).
  
  
  OBJECTIVE
  The aim of this study was to evaluate possible risk factors, clinical characteristics, and outcomes of CRKP infections compared with CSKP infections in kidney transplant recipients (KTR).
  
  
  METHODS
  We retrospectively investigated 13 CRKP infections and 39 CSKP infections in KTR (2006-2010).
  
  
  RESULTS
  CRKP was not significantly associated with age, gender, or comorbidities. CRKP infections were significantly associated with recent exposure to broad-spectrum antibiotics and were more likely to have been managed on an inpatient basis and to have required source control. CRKP was significantly associated with earlier mortality. Six of 13 (46%) patients with CRKP infection, and none of the patients with CSKP infection, died within 6.5 months of infection onset. Although cases and controls did not differ significantly with respect to diabetes, all patients (100%, n = 9) who died during the study had diabetes, while 58% of the 43 survivors had diabetes (P = 0.02).
  
  
  CONCLUSIONS
  In conclusion, CRKP compared with CSKP is associated with greater risk of mortality. Investigations on ways to better prevent CRKP are urgently needed.
authors.affiliation: Department of Medicine, Division of Infectious Diseases at Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: J
authors.initials: J
authors.lastname: Simkins
authors.forename: V
authors.initials: V
authors.lastname: Muggia
authors.forename: H W
authors.initials: HW
authors.lastname: Cohen
authors.forename: G Y
authors.initials: GY
authors.lastname: Minamoto
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015780:Carbapenems / Q000627:therapeutic use*; D016022:Case-Control Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D024881:Drug Resistance, Bacterial; D005260:Female; D006760:Hospitalization; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems
keywords: Klebsiella pneumoniae infection; carbapenem resistance; kidney transplantation