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Risk Factors for Acquisition of Carbapenem-Resistant Klebsiella pneumoniae and Mortality Among Abdominal Solid Organ Transplant Recipients with K. pneumoniae Infections

Di Wu, Chunmei Chen, Taohua Liu, Qiquan Wan

Department of Transplantation, Xiangya Third Hospital of Central South University, Changsha, Hunan, China (mainland)

Med Sci Monit 2020; 26:e922996

DOI: 10.12659/MSM.922996

Available online: 2020-06-18

Published: 2020-08-18

BACKGROUND: For abdominal solid organ transplant (ASOT) recipients, infection with Klebsiella pneumoniae, particularly carbapenem-resistant K. pneumoniae (CRKP), can be life-threatening. The aims of this study were to characterize the risk factors associated with acquisition of CRKP and 90-day crude mortality among patients.
MATERIAL AND METHODS: In our cohort study, we retrospectively reviewed 68 K. pneumoniae-infected transplant recipients, studied their demographics, clinical manifestations, microbiology, and outcomes, and determined the risk factors associated with the occurrence of CRKP and crude mortality due to K. pneumoniae infections.
RESULTS: Sixty-eight ASOT recipients (5.4%) experienced 78 episodes of K. pneumoniae infection. Among these, 20 patients (29.4%) died. The independent risk factors associated with mortality were multiple infected organs or sites (odds ratio=22.034, 95% confidence intervals=4.348-111.653, P=0.001) and septic shock (odds ratio=27.090, 95% confidence intervals=1.841-398.512, P=0.016). Risk factors associated with acquisition of CRKP were multiple infected organs or sites (odds ratio=3.056, 95% confidence intervals=1.091-8.556, P=0.033).
CONCLUSIONS: K. pneumoniae infections, especially CRKP, frequently occurred among ASOT recipients, with a high mortality rate. Multiple infected organs or sites and septic shock were predictors of crude mortality caused by K. pneumoniae infections, while CRKP infections were associated with multiple infected organs or sites. Greater efforts are needed towards improved antibiotic administration, early diagnosis and precise treatment, recognition of septic shock, and reduced length of hospitalization.

Keywords: Carbapenems, Drug Resistance, Bacterial, Gram-Negative Bacterial Infections, Mortality, Risk Factors, Transplants