title: Carbapenem-Resistant Klebsiella pneumoniae influences the outcome of early infections in liver transplant recipients.
abstract: BACKGROUND
  Infections remain a leading cause of morbidity and mortality among liver transplant (LT) recipients. The aim of our study was to define the factors associated with outcome of early bacterial and fungal infections in a cohort of patients who underwent LT at the University Hospital of Ancona over a nine year period.
  
  
  METHODS
  All consecutive patients who underwent LT in our center were considered. An early infection was defined as occurring in the first month post-transplantation.
  
  
  RESULTS
  Among 330 patients who underwent LT from August 2005 to October 2014, 88 (27 %) had at least one infection documented within 30 days after transplantation. In 54 cases only one site was involved, in 34 cases ≥2 sites. There were 43 (30 %) pneumonia, 40 (27 %) surgical site infections, 31 (22 %) blood stream infections, and 30 (21 %) urinary tract infections. Gram-negative bacteria accounted for 64 % of the culture-positive cases, followed by Gram-positive bacteria (30 %) and fungi (6 %). A high proportion of drug-resistant strains was found within either Gram-negative (79 %) or Gram-positive (81 %) bacteria. There were 27 out 88 patients (31 %) who died within 180 days from the transplant. Factors independently associated with a higher risk of mortality were: renal replacement therapy (HR 11.797 [CI95 % 3.082-45.152], p < 0.0001), multisite infections (HR 4.865 [CI95 % 1.417-16.700], p = 0.012) and being infected with carbapenem-resistant Klebsiella pneumoniae (CRKP; HR 5.562 [CI95 % 1.186-26.088], p = 0.030).
  
  
  CONCLUSIONS
  Overall, these data indicate that early infections in LT patients are characterized by significant mortality. In particular, an early infection caused by CRKP has an adverse impact on survival in these patients suggesting an urgent need for adopting preventive measures to avoiding this complication.
authors.affiliation: Clinica Malattie Infettive, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I°-Lancisi-Salesi, Via Conca, 60126, Ancona, Italy. f.barchiesi@univpm.it.
authors.forename: Francesco
authors.identifier: http://orcid.org/0000-0003-1098-902X
authors.initials: F
authors.lastname: Barchiesi
authors.affiliation: Chirurgia Epatobiliare e dei Trapianti, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umbero I°-Lancisi-Salesi, Ancona, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Montalti
authors.affiliation: Clinica Malattie Infettive, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I°-Lancisi-Salesi, Via Conca, 60126, Ancona, Italy.
authors.forename: Pamela
authors.initials: P
authors.lastname: Castelli
authors.affiliation: Chirurgia Epatobiliare e dei Trapianti, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umbero I°-Lancisi-Salesi, Ancona, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Nicolini
authors.affiliation: Clinica Malattie Infettive, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I°-Lancisi-Salesi, Via Conca, 60126, Ancona, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Staffolani
authors.affiliation: Chirurgia Epatobiliare e dei Trapianti, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umbero I°-Lancisi-Salesi, Ancona, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Mocchegiani
authors.affiliation: Clinica Malattie Infettive, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I°-Lancisi-Salesi, Via Conca, 60126, Ancona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fiorentini
authors.affiliation: Laboratorio di Microbiologia, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I°-Lancisi-Salesi, Ancona, Italy.
authors.forename: Esther
authors.initials: E
authors.lastname: Manso
authors.affiliation: Chirurgia Epatobiliare e dei Trapianti, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umbero I°-Lancisi-Salesi, Ancona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Vivarelli
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015780:Carbapenems / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification / Q000472:pathogenicity; D006801:Humans; D007558:Italy; D007710:Klebsiella Infections / Q000188:drug therapy / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000472:pathogenicity; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000188:drug therapy; D014552:Urinary Tract Infections / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems
keywords: Antibiotic resistance; Carbapenem-resistant Klebsiella pneumonaie; Early infections; Immunosuppression; Liver transplantation