title: Risk factors for infection with carbapenem-resistant Klebsiella pneumoniae after liver transplantation: the importance of pre- and posttransplant colonization.
abstract: Improved understanding of risk factors associated with carbapenem-resistant-Klebsiella pneumoniae (CR-KP) infection after liver transplantation (LT) can aid development of effective preventive strategies. We performed a prospective cohort study of all adult patients undergoing LT at our hospital during 30-month period to define risk factors associated with CR-KP infection. All patients were screened for CR-KP carriage by rectal swabs before and after LT. No therapy was administered to decolonize or treat asymptomatic CR-KP carriers. All patients were monitored up to 180 days after LT. Of 237 transplant patients screened, 41 were identified as CR-KP carriers (11 at LT, 30 after LT), and 20 developed CR-KP infection (18 bloodstream-infection, 2 pneumonia) a median of 41.5 days after LT. CR-KP infection rates among patients non-colonized, colonized at LT, and colonized after LT were 2%, 18.2% and 46.7% (p < 0.001). Independent risk factors for CR-KP infection identified by multivariate analysis, included: renal-replacement-therapy; mechanical ventilation > 48 h; HCV recurrence, and colonization at any time with CR-KP. Based on these four variables, we developed a risk score that effectively discriminated patients at low versus higher risk for CR-KP infection (AUC 0.93, 95% CI 0.86-1.00, p < 0.001). Our results may help to design preventive strategies for LT recipients in CR-KP endemic areas.
authors.affiliation: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater University of Bologna, Bologna, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Giannella
authors.affiliation: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater University of Bologna, Bologna, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Bartoletti
authors.affiliation: Internal Medicine Unit for the Treatment of Severe Organ Failure, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: M C
authors.initials: MC
authors.lastname: Morelli
authors.affiliation: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater University of Bologna, Bologna, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Tedeschi
authors.affiliation: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater University of Bologna, Bologna, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Cristini
authors.affiliation: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater University of Bologna, Bologna, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Tumietto
authors.affiliation: Liver and Multiorgan Transplant Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Pasqualini
authors.affiliation: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater University of Bologna, Bologna, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Danese
authors.affiliation: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater University of Bologna, Bologna, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Campoli
authors.affiliation: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater University of Bologna, Bologna, Italy.
authors.forename: N Di
authors.initials: ND
authors.lastname: Lauria
authors.affiliation: Anesthesia Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Faenza
authors.affiliation: Liver and Multiorgan Transplant Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Ercolani
authors.affiliation: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater University of Bologna, Bologna, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Lewis
authors.affiliation: Liver and Multiorgan Transplant Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: A D
authors.initials: AD
authors.lastname: Pinna
authors.affiliation: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater University of Bologna, Bologna, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Viale
mesh_terms: D000328:Adult; D000368:Aged; D015780:Carbapenems / Q000627:therapeutic use*; D002353:Carrier State / Q000382:microbiology*; D015331:Cohort Studies; D015169:Colony Count, Microbial; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D015994:Incidence; D007710:Klebsiella Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D007711:Klebsiella pneumoniae / Q000302:isolation & purification*; D016031:Liver Transplantation; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D015780:Carbapenems
keywords: dendritic cell; editorial/personal viewpoint; immune regulation; immunobiology; infectious disease; innate immunity; intestinal biology; microbiomics; translational research/science