S M Pouch1, C J Kubin2,3, M J Satlin3,4, D S Tsapepas3, J R Lee3,4, G Dube2,3, M R Pereira2,3. 1. Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA. 2. Department of Medicine, Columbia University Medical Center, New York, New York, USA. 3. NewYork-Presbyterian Hospital, New York, New York, USA. 4. Department of Medicine, Weill Cornell Medical College, New York, New York, USA.
Abstract
BACKGROUND: Little is known about the epidemiology of carbapenem-resistant Klebsiella pneumoniae (CRKP) bacteriuria following kidney transplantation. We determined the incidence of post-transplant CRKP bacteriuria in adults who underwent kidney transplant from 2007 to 2010 at 2 New York City centers. METHODS: We conducted a case-control study to identify factors associated with CRKP bacteriuria compared with carbapenem-susceptible K. pneumoniae (CSKP) bacteriuria, assessed whether CRKP bacteriuria was associated with mortality or graft failure, and compared outcomes of treated episodes of CRKP and CSKP bacteriuria. RESULTS: Of 1852 transplants, 20 (1.1%) patients developed CRKP bacteriuria. Factors associated with CRKP bacteriuria included receipt of multiple organs (odds ratio [OR] 4.7, 95% confidence interval [CI] 1.1-20.4), deceased-donor allograft (OR 5.9, 95% CI 1.3-26.8), transplant admission length of stay (OR 1.1 per day, 95% CI 1.0-1.1), pre-transplant CRKP infection or colonization (OR 18.3, 95% CI 2.0-170.5), diabetes mellitus (OR 2.8, 95% CI 1.0-7.8), and receipt of antimicrobials other than trimethoprim-sulfamethoxazole (OR 4.3, 95% CI 1.6-11.2). CONCLUSION: Compared to CSKP bacteriuria, CRKP bacteriuria was associated with increased mortality (30% vs. 10%, P = 0.03) but not graft failure. Treated episodes of CRKP bacteriuria were less likely to achieve microbiologic clearance (83% vs. 97%; P = 0.05) and more likely to recur within 3 months (50% vs. 22%, P = 0.02) than CSKP episodes. CRKP bacteriuria after kidney transplant is associated with mortality and antimicrobial failure after treatment.
BACKGROUND: Little is known about the epidemiology of carbapenem-resistant Klebsiella pneumoniae (CRKP) bacteriuria following kidney transplantation. We determined the incidence of post-transplant CRKP bacteriuria in adults who underwent kidney transplant from 2007 to 2010 at 2 New York City centers. METHODS: We conducted a case-control study to identify factors associated with CRKP bacteriuria compared with carbapenem-susceptible K. pneumoniae (CSKP) bacteriuria, assessed whether CRKP bacteriuria was associated with mortality or graft failure, and compared outcomes of treated episodes of CRKP and CSKP bacteriuria. RESULTS: Of 1852 transplants, 20 (1.1%) patients developed CRKP bacteriuria. Factors associated with CRKP bacteriuria included receipt of multiple organs (odds ratio [OR] 4.7, 95% confidence interval [CI] 1.1-20.4), deceased-donor allograft (OR 5.9, 95% CI 1.3-26.8), transplant admission length of stay (OR 1.1 per day, 95% CI 1.0-1.1), pre-transplant CRKP infection or colonization (OR 18.3, 95% CI 2.0-170.5), diabetes mellitus (OR 2.8, 95% CI 1.0-7.8), and receipt of antimicrobials other than trimethoprim-sulfamethoxazole (OR 4.3, 95% CI 1.6-11.2). CONCLUSION: Compared to CSKP bacteriuria, CRKP bacteriuria was associated with increased mortality (30% vs. 10%, P = 0.03) but not graft failure. Treated episodes of CRKP bacteriuria were less likely to achieve microbiologic clearance (83% vs. 97%; P = 0.05) and more likely to recur within 3 months (50% vs. 22%, P = 0.02) than CSKP episodes. CRKP bacteriuria after kidney transplant is associated with mortality and antimicrobial failure after treatment.
Authors: M D Bergamasco; M Barroso Barbosa; D de Oliveira Garcia; R Cipullo; J C M Moreira; C Baia; V Barbosa; C S Abboud Journal: Transpl Infect Dis Date: 2011-10-28 Impact factor: 2.228
Authors: P S Almond; A Matas; K Gillingham; D L Dunn; W D Payne; P Gores; R Gruessner; J S Najarian Journal: Transplantation Date: 1993-04 Impact factor: 4.939
Authors: Andrea Endimiani; Andrea M Hujer; Federico Perez; Christopher R Bethel; Kristine M Hujer; Jennifer Kroeger; Margret Oethinger; David L Paterson; Mark D Adams; Michael R Jacobs; Daniel J Diekema; Gerri S Hall; Stephen G Jenkins; Louis B Rice; Fred C Tenover; Robert A Bonomo Journal: J Antimicrob Chemother Date: 2009-01-20 Impact factor: 5.790
Authors: Jessica R Howard-Anderson; Chris W Bower; Gillian Smith; Mary Elizabeth Sexton; Monica M Farley; Sarah W Satola; Jesse T Jacob Journal: Infect Control Hosp Epidemiol Date: 2020-12-10 Impact factor: 6.520
Authors: David M Jacobs; M Courtney Safir; Dennis Huang; Faisal Minhaj; Adam Parker; Gauri G Rao Journal: Ann Clin Microbiol Antimicrob Date: 2017-11-25 Impact factor: 3.944