Control of infectious mortality due to carbapenemase-producing Klebsiella pneumoniae in hematopoietic stem cell transplantation.
Carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) infections are an emerging cause of death after hematopoietic stem cell transplantation (HSCT). In allogeneic transplants, mortality rate may rise up to 60%. We retrospectively evaluated 540 patients receiving a transplant from an auto- or an allogeneic source between January 2011 and October 2015. After an Institutional increase in the prevalence of KPC-Kp bloodstream infections (BSI) in June 2012, from July 2012, 366 consecutive patients received the following preventive measures: (i) weekly rectal swabs for surveillance; (ii) contact precautions in carriers (iii) early-targeted therapy in neutropenic febrile carriers. Molecular typing identified KPC-Kp clone ST512 as the main clone responsible for colonization, BSI and outbreaks. After the introduction of these preventive measures, the cumulative incidence of KPC-Kp BSI (P=0.01) and septic shocks (P=0.01) at 1 year after HSCT was significantly reduced. KPC-Kp infection-mortality dropped from 62.5% (pre-intervention) to 16.6% (post-intervention). Day 100 transplant-related mortality and KPC-Kp infection-related mortality after allogeneic HSCT were reduced from 22% to 10% (P=0.001) and from 4% to 1% (P=0.04), respectively. None of the pre-HSCT carriers was excluded from transplant. These results suggest that active surveillance, contact precautions and early-targeted therapies, may efficiently control KPC-Kp spread and related mortality even after allogeneic HSCT.
Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy.|University Vita-Salute San Raffaele, Milan, Italy.
A
A
Forcina
Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
R
R
Baldan
University Vita-Salute San Raffaele, Milan, Italy.
V
V
Marasco
Microbiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
P
P
Cichero
Innovative Immunotherapies Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
A
A
Bondanza
Experimental Hematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
M
M
Noviello
Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy.
S
S
Piemontese
Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy.
C
C
Soliman
Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy.
R
R
Greco
Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy.|University Vita-Salute San Raffaele, Milan, Italy.
F
F
Lorentino
Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy.
F
F
Giglio
Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy.
C
C
Messina
Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy.
M
M
Carrabba
Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy.
M
M
Bernardi
Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy.
J
J
Peccatori
Infections Control Committee, IRCCS San Raffaele Scientific Institute, Milan, Italy.
M
M
Moro
Infections Control Committee, IRCCS San Raffaele Scientific Institute, Milan, Italy.
A
A
Biancardi
Infections Control Committee, IRCCS San Raffaele Scientific Institute, Milan, Italy.
P
P
Nizzero
Infectious Disease Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
P
P
Scarpellini
Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
D M
DM
Cirillo
Microbiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
N
N
Mancini
Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy.
C
C
Corti
University Vita-Salute San Raffaele, Milan, Italy.|Microbiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
M
M
Clementi
Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy.|University Vita-Salute San Raffaele, Milan, Italy.
F
F
Ciceri
D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D064592:Autografts; D001426:Bacterial Proteins / Q000096:biosynthesis*; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007710:Klebsiella Infections / Q000235:genetics / Q000401:mortality / Q000628:therapy; D007711:Klebsiella pneumoniae / Q000235:genetics / Q000378:metabolism / Q000472:pathogenicity; D008297:Male; D008875:Middle Aged; D012772:Shock, Septic / Q000235:genetics / Q000401:mortality / Q000628:therapy; D001618:beta-Lactamases / Q000096:biosynthesis*
D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase
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