title: Risk factors and outcome of infections with Klebsiella pneumoniae carbapenemase-producing K. pneumoniae in kidney transplant recipients.
abstract: BACKGROUND
  Solid organ transplant recipients are especially susceptible to healthcare-associated infections with Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp-HAIs). The aim of the study was to evaluate risk factors and outcome of these infections in kidney transplant recipients.
  
  
  METHODS
  This was a retrospective cohort of kidney transplant (KTx) recipients between January 2009 and December 2013. Cases were defined as patients who developed KPC-Kp-HAI, confirmed by PCR for bla( KPC) gene after KTx during the study period. We analysed variables related to recipient; induction immunosuppressant therapy; delayed graft function; use of invasive devices; SOFA score on the first day of infection; type of therapy; time from positive culture to appropriate antimicrobial therapy; bacteraemia; and concomitant infection. Outcome measures were the occurrence of KPC-Kp-HAI and 30-day mortality after KPC-Kp-HAI.
  
  
  RESULTS
  A total of 1,101 were submitted to KTx in the period, 21 patients were classified as infected with KPC-Kp. Another ten patients had KPC-Kp-HAI in the period and were transplanted before 2009. Of those 31 patients, 48.4 % showed evidence of prior colonization and 38.7 % had bacteraemia. The most common site of infection was the surgical wound. Risk factors for KPC-Kp-HAI were multi-organ transplantation and the use of a ureteral stent. Eight of the infected patients experienced recurrence of the infection. The 30-day mortality rate was 41.9 %. Survival was significantly lower among the patients with KPC-Kp-HAI (72 vs. 89.1 %; P = 0.002). The only risk factor independently associated with 30-day mortality was an elevated SOFA score on the first day of infection.
  
  
  CONCLUSIONS
  In KTx recipients, the occurrence of KPC-Kp-HAI was related to invasive devices and type of transplant; these infections had a high rate of recurrence and reduced survival after KTx.
authors.affiliation: Working Committee for Hospital Epidemiology and Infection Control, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr Eneas de Carvalho Aguiar, 255, São Paulo, SP, 05403-900, Brazil, maristelapf@uol.com.br.
authors.forename: Maristela P
authors.initials: MP
authors.lastname: Freire
authors.forename: Edson
authors.initials: E
authors.lastname: Abdala
authors.forename: Maria L
authors.initials: ML
authors.lastname: Moura
authors.forename: Flávio Jota
authors.initials: FJ
authors.lastname: de Paula
authors.forename: Fernanda
authors.initials: F
authors.lastname: Spadão
authors.forename: Hélio H
authors.initials: HH
authors.lastname: Caiaffa-Filho
authors.forename: Elias
authors.initials: E
authors.lastname: David-Neto
authors.forename: William C
authors.initials: WC
authors.lastname: Nahas
authors.forename: Ligia C
authors.initials: LC
authors.lastname: Pierrotti
mesh_terms: D000368:Aged; D001426:Bacterial Proteins / Q000235:genetics / Q000378:metabolism*; D004269:DNA, Bacterial / Q000235:genetics; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D066027:Transplant Recipients; D016896:Treatment Outcome; D055815:Young Adult; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
chemical_list: D001426:Bacterial Proteins; D004269:DNA, Bacterial; D001618:beta-Lactamases; C063912:carbapenemase