title: Bloodstream infections caused by carbapenemase-producing Klebsiella pneumoniae among intensive care unit patients after orthotopic liver transplantation: risk factors for infection and impact of resistance on outcomes.
abstract: BACKGROUND
  Carbapenem-resistant Klebsiella pneumoniae (CRKP) has emerged as an important cause of bloodstream infections in intensive care units (ICUs). The aim of this study was to determine risk factors for bloodstream infections caused by CRKP as well as risk factors for CRKP-associated mortality among ICU patients after orthotopic liver transplantation (LT).
  
  
  METHODS
  The study cohort of this observational study comprised 17 ICU patients after LT with CRKP bloodstream infections. The data from these patients were matched with 34 ICU patients (1:2) after LT without CRKP infections. The 2 groups were compared to identify risk factors for development of CRKP infection and risk factors for mortality.
  
  
  RESULTS
  Seventeen CRKP bloodstream infections occurred in ICU patients after LT from January 1, 2008, to December 31, 2011. In univariate analysis, primary liver disease and especially hepatitis C virus infection or hepatocellular cancer were significant factors for development of CRKP. Acute Physiology and Chronic Health Evaluation (APACHE II) score and Sequential Organ Failure Assessment (SOFA) score as well as CRKP bloodstream infection were predictors for ICU death (P < .05) in univariate analysis.
  
  
  CONCLUSIONS
  CRKP bloodstream infections affect immunocompromised post-transplantation patients more. Bloodstream infections with CRKP along with APACHE and SOFA scores were predictors of death in ICU patients after LT.
authors.affiliation: Intensive Care Unit, "Hippokratio" University Hospital, Thessaloniki, Greece. Electronic address: elmoulou@yahoo.gr.
authors.forename: E
authors.initials: E
authors.lastname: Mouloudi
authors.affiliation: Intensive Care Unit, "Hippokratio" University Hospital, Thessaloniki, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Massa
authors.affiliation: Intensive Care Unit, "Hippokratio" University Hospital, Thessaloniki, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Papadopoulos
authors.affiliation: Infection Control Unit, "Hippokratio" University Hospital, Thessaloniki, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Iosifidis
authors.affiliation: Infection Control Unit, "Hippokratio" University Hospital, Thessaloniki, Greece.
authors.forename: I
authors.initials: I
authors.lastname: Roilides
authors.affiliation: Intensive Care Unit, "Hippokratio" University Hospital, Thessaloniki, Greece.
authors.forename: T
authors.initials: T
authors.lastname: Theodoridou
authors.affiliation: Intensive Care Unit, "Hippokratio" University Hospital, Thessaloniki, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Piperidou
authors.affiliation: Microbiology Department, "Hippokratio" University Hospital, Thessaloniki, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Orphanou
authors.affiliation: Intensive Care Unit, "Hippokratio" University Hospital, Thessaloniki, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Passakiotou
authors.affiliation: Transplantation Unit, "Hippokratio" University Hospital, Thessaloniki, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Imvrios
authors.affiliation: Transplantation Unit, "Hippokratio" University Hospital, Thessaloniki, Greece.
authors.forename: I
authors.initials: I
authors.lastname: Fouzas
authors.affiliation: Transplantation Unit, "Hippokratio" University Hospital, Thessaloniki, Greece.
authors.forename: V
authors.initials: V
authors.lastname: Papanikolaou
authors.affiliation: Intensive Care Unit, "Hippokratio" University Hospital, Thessaloniki, Greece.
authors.forename: N
authors.initials: N
authors.lastname: Gritsi-Gerogianni
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D001426:Bacterial Proteins / Q000096:biosynthesis*; D024881:Drug Resistance, Bacterial; D005260:Female; D005500:Follow-Up Studies; D006115:Greece / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000302:isolation & purification; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase