title: Risk factors and outcomes of carbapenem-resistant Klebsiella pneumoniae infections in liver transplant recipients.
abstract: Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection is increasing in incidence and is associated with increased mortality in liver transplantation (LT) recipients. We performed a retrospective cohort study of all patients transplanted between January 2010 and January 2013 to identify the incidence and risk factors for post-LT CRKP infection and evaluate the impact of this infection on outcomes in a CRKP-endemic area. We studied 304 recipients, of whom 20 (6.6%) developed CRKP and 36 (11.8%) carbapenem-susceptible Klebsiella pneumoniae (CSKP) infections in the year following LT. Among the 20 recipients with post-LT CRKP infection, 8 (40%) were infected in ≥ 2 sites; 13 (65%) had surgical site-intra-abdominal infections; 12 (60%) had pneumonia; and 3 (15%) had a urinary tract infection. There were 6 patients with a CRKP infection before LT, 5 of whom developed a CRKP infection after LT. Significant risk factors for post-LT CRKP infection in multivariate analysis included laboratory Model for End-Stage Liver Disease at LT (odds ratio [OR], 1.07; P = 0.001), hepatocellular carcinoma (OR, 3.19; P = 0.02), Roux-en-Y biliary choledochojejunostomy (OR, 3.15; P = 0.04), and bile leak (OR, 5.89; P = 0.001). One-year estimated patient survival was 55% (95% confidence interval, 31%-73%), 72% (55%-84%), and 93% (89%-96%), for patients with CRKP, CSKP, and no Klebsiella pneumoniae infection, respectively. In multivariate analysis, CRKP (hazard ratio [HR], 6.92; P < 0.001) and CSKP infections (CSKP, HR, 3.84; P < 0.001), as well as bile leak (HR, 2.10; P = 0.03) were the strongest predictors of post-LT mortality. In an endemic area, post-LT CRKP infection is common, occurring in 6.6% of recipients, and is strongly associated with post-LT mortality. Improved strategies for screening and prevention of CRKP infection are urgently needed.
authors.affiliation: Division of Infectious Diseases.
authors.forename: Marcus R
authors.initials: MR
authors.lastname: Pereira
authors.affiliation: Department of Medicine.|Department of Surgery.
authors.forename: Brendan F
authors.initials: BF
authors.lastname: Scully
authors.affiliation: Department of Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Pouch
authors.affiliation: Division of Infectious Diseases.|Department of Medicine.
authors.forename: Anne-Catrin
authors.initials: AC
authors.lastname: Uhlemann
authors.affiliation: Center for Liver Disease and Transplantation, Columbia University Medical Center, New York, NY.
authors.forename: Stella
authors.initials: S
authors.lastname: Goudie
authors.affiliation: Department of Surgery.|Center for Liver Disease and Transplantation, Columbia University Medical Center, New York, NY.
authors.forename: Jean E
authors.initials: JE
authors.lastname: Emond
authors.affiliation: Department of Medicine.|Department of Surgery.|Center for Liver Disease and Transplantation, Columbia University Medical Center, New York, NY.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Verna
mesh_terms: D015780:Carbapenems; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000401:mortality*; D007711:Klebsiella pneumoniae / Q000502:physiology*; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D015780:Carbapenems