title: Management of carbapenem-resistant K. pneumoniae in allogenic stem cell transplant recipients: the Turin bundle.
abstract: Carbapenem resistance has evolved rapidly since 2001 and the distribution of Carbapenemase-producing Klebsiella pneumoniae (CR-Kp) is currently a public health concern worldwide. In the haematological setting, especially in allogenic transplant, CR-KP infections were associated with a mortality up to 65%. Aim of this report is to describe the management of patients colonized by CR-Kp and undergoing allo- HSCT with a multiple-step intervention strategy: the "Turin bundle". Steps included oral gentamicin (GO) within 20 days before allo-HSCT, avoidance of levofloxacin prophylaxis during neutropenia, treatment of febrile neutropenia with tigecycline 100 mg bid and piperacillin-tazobactam at standard dosages and early appropriate combination therapy for patients with severe sepsis. In our small series all patients survived, no resistance to oral gentamicin was observed and 60% of patients had negative rectal swabs after transplant.
authors.affiliation: Department of Medical Sciences, Infectious Diseases, University of Turin, Italy.
authors.forename: Francesco Giuseppe
authors.initials: FG
authors.lastname: De Rosa
authors.affiliation: Department of Medical Sciences, Infectious Diseases, University of Turin, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Corcione
authors.affiliation: Department of Medical Sciences, Infectious Diseases, University of Turin, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Raviolo
authors.affiliation: Department of Oncology, Allogenic Haematopoietic Stem Cell Transplant Unit, City of Health and Science of Turin, Molinette Hospital, University of Turin, Italy.
authors.forename: Benedetto
authors.initials: B
authors.lastname: Bruno
authors.affiliation: Department of Oncology, Allogenic Haematopoietic Stem Cell Transplant Unit, City of Health and Science of Turin, Molinette Hospital, University of Turin, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Busca
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015780:Carbapenems / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007558:Italy; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D033581:Stem Cell Transplantation
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems
keywords: Allogenic haematopoietic stem cell transplant (HSCT); Carbapenem-sparing strategies; Carbapenemase-producing Klebsiella pneumonia; Decontamination; Mortality