title: Infections by carbapenem-resistant Klebsiella pneumoniae in SCT recipients: a nationwide retrospective survey from Italy.
abstract: Infections by carbapenem-resistant Klebsiella pneumoniae (CRKp) represent a challenging problem after SCT. A retrospective survey (January 2010 to July 2013) involving 52 Italian centers was performed to assess the epidemiology and the prognostic factors of CRKp infections in auto- and allo-SCT. Cases of CRKp infection were reported in 53.4% of centers. CRKp infections were documented in 25 auto-SCTs and 87 allo-SCTs, with an incidence of 0.4% (from 0.1% in 2010 to 0.7% in 2013) and 2% (from 0.4% in 2010 to 2.9% in 2013), respectively. A CRKp colonization documented before or after transplant was followed by an infection in 25.8% of auto-SCT and 39.2% of allo-SCT patients. The infection-related mortality rates were 16% and 64.4%, respectively. A pre-transplant CRKp infection (hazard ratio (HR) 0.33, 95% confidence intervals (CIs) 0.15-0.74; P=0.007) and a not CRKp-targeted first-line treatment (HR 2.67, 95% CI 1.43-4.99; P=0.002) were independent factors associated with an increased mortality in allo-SCT patients who developed a CRKp infection. Our study shows challenging findings of CRKp infections in SCT patients in Italy particularly after allo-SCT. The detection of carriers and the definition of early therapeutic strategies represent critical aspects of the management of CRKp infections after SCT.
authors.affiliation: Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Girmenia
authors.affiliation: 1] Dipartimento di Biotecnologie Mediche, University of Siena, Siena, Italy [2] Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Florence, Italy [3] SOD Microbiologia e Virologia, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
authors.forename: G M
authors.initials: GM
authors.lastname: Rossolini
authors.affiliation: Fondazione GIMEMA (Gruppo Italiano Malattie EMatologiche dell'Adulto) Data Center, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Piciocchi
authors.affiliation: Unità Operativa di Oncoematologia, Ospedale pediatrico Bambino Gesù, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bertaina
authors.affiliation: Divisione di Ematologia con Unità di Trapianto di Midollo- Ospedale S.G. Moscati, Taranto, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Pisapia
authors.affiliation: UO di Ematologia con Trapianto, Dipartimento di Emergenza e Trapianto d'Organo, University of Bari, Bari, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Pastore
authors.affiliation: Divisione di Ematologia-Istituto di Ematologia, Policlinico A. Gemelli, Università Cattolica S. Cuore, Rome, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Sica
authors.affiliation: UOC di Ematologia e Trapianti di Cellule Staminali, Az. Osp. S.Camillo-Forlanini, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Severino
authors.affiliation: Fondazione Policlinico Tor Vergata, Unità di Trapianto Cellule Staminali, University Tor Vergata, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Cudillo
authors.affiliation: Unità operative di Ematologia e trapianto Midollo Osseo, Ospedale San Raffaele, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Ciceri
authors.affiliation: UOC di Ematologia, A.O. Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Scimè
authors.affiliation: Centro Nazionale Trapianti, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Lombardini
authors.affiliation: Dipartimento di Malattie Infettive, IRCCS S. Martino University Hospital-IST, Genoa, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Viscoli
authors.affiliation: Divisione di Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Rambaldi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D064592:Autografts; D015780:Carbapenems; D024881:Drug Resistance, Bacterial; D005260:Female; D006402:Hematologic Diseases / Q000401:mortality / Q000628:therapy; D006801:Humans; D007558:Italy; D007710:Klebsiella Infections / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D007711:Klebsiella pneumoniae; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D033581:Stem Cell Transplantation
chemical_list: D015780:Carbapenems